Low-dose fluticasone is less expensive and more effective than montelukast in children with asthma

This study compared the cost-effectiveness of 2 commonly used asthma controllers, fluticasone and montelukast in a randomized, controlled, multicenter clinical trial in children with mild-to-moderate persistent asthma.

Effectiveness measures included:

- number of asthma-control days
- percentage of participants with an increase over baseline of FEV(1) of 12% or greater
- number of exacerbations

For all cost-effectiveness measures studied, fluticasone cost less and was more effective than montelukast. For example, fluticasone treatment cost $430 less and resulted in 40 more asthma-control days during the 48-week study period.

For children with mild-to-moderate persistent asthma, low-dose fluticasone had lower cost and higher effectiveness compared with montelukast, especially in those with more airway inflammation (indicated by increased eNO and more responsivity to methacholine).

However, montelukast will be generic in the U.S. in 2012 and this will definitely affect its cost-effectiveness.


Cost-effectiveness analysis of fluticasone versus montelukast in children with mild-to-moderate persistent asthma in the Pediatric Asthma Controller Trial. Wang L, Hollenbeak CS, Mauger DT, Zeiger RS, Paul IM, Sorkness CA, Lemanske RF Jr, Martinez FD, Strunk RC, Szefler SJ, Taussig LM; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute. J Allergy Clin Immunol. 2011 Jan;127(1):161-166.e1.

Montelukast failure index that may be helpful in predicting response in patients with asthma http://goo.gl/AzRPF

Image source: Montelukast, Wikipedia, public domain.

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