Cost-Efficacy Analysis of Fluticasone Propionate versus Zafirlukast in Patients with Persistent Asthma

Objective: To compare the relative value of an inhaled corticosteroid, fluticasone propionate 88microg twice daily, versus an oral leukotriene receptor antagonist, zafirlukast 20mg twice daily, in patients with persistent asthma currently receiving short acting beta2-agonists alone. Study design: A cost-efficacy analysis using resource utilisation and clinical data obtained prospectively from a multicentre, randomised, double-blind, double-dummy, placebo-controlled 12-week clinical trial conducted in the US. Perspective: Third-party payor. Patients and methods: A total of 451 corticosteroid-naive patients with persistent asthma were treated with either fluticasone propionate 88microg twice daily or zafirlukast 20mg twice daily. All patients were given salbutamol (albuterol) to be used as rescue medication. Data were examined using intent-to-treat analysis. Results: Mean daily per person cost-efficacy ratios using improvement in forced expiratory volume in 1 second (FEV1) [>=12% increase from baseline] were $US3.47 for fluticasone propionate compared with $US7.81 for zafirlukast (1999 values). The mean daily per person cost-efficacy ratios for symptom-free days obtained were $US5.51 for fluticasone propionate compared with $US14.98 for zafirlukast. These cost-efficacy ratios remained in favour of fluticasone propionate after a robust sensitivity analysis. Conclusions: Treatment with fluticasone propionate 88microg twice daily was the most cost effective treatment compared with zafirlukast 20mg twice daily in this 12-week clinical trial. This analysis supports the use of fluticasone propionate 88microg twice daily as first-line treatment in patients with persistent asthma previously treated with short-acting beta2-agonist alone.