Comparison of ﬁxed-dose combinations for asthma 1877 Table 5 Secondary treatment outcomes in the post-index year Outcomes Asthma exacerbations (mean episodes ⁄ patient) SABA use (mean number of doses ⁄ patient ⁄ day) OCS (mean prescriptions ⁄ patient) Asthma-related referrals (mean number ⁄ patient) Asthma-related hospitalisations (mean number ⁄ patient) SAL ⁄ FLU group (n = 982) 0.20 0.60 0.30 0.19 0.021 BUD ⁄ FORM group (n = 1456) 0.10 0.52 0.17 0.18 0.012 Relative difference (BUD ⁄ FORM vs. SAL ⁄ FLU) Crude (%) Adjusted* (%) p-value* )47.3 )13.7 )47.3 )9.5 )45.4 )33.4 )8.7 )31.5 )9.5 )2.9 0.0123 0.2297 0.0082 0.4358 0.7228 *Adjusted for pre-index inhaled corticosteroid, long-acting b2-agonist and short-acting b2-agonist (SABA) use, gender and numbers of exacerbations, oral corticosteroid (OCS) prescriptions, referrals and hospitalisations over the pre-index period. BUD ⁄ FORM, budeso- nide ⁄ formoterol; SAL ⁄ FLU, salmeterol ⁄ ﬂuticasone. difference in the mean numbers of asthma-related referrals or hospitalisations between the budeso- nide ⁄ formoterol and the salmeterol ⁄ ﬂuticasone groups and mean SABA use did not differ between groups in the postindex year. However, overall OCS prescriptions were more frequent in the salmeter- ol ⁄ ﬂuticasone-treated patients compared with the budesonide ⁄ formoterol-treated patients. Almost half of the patients in both the salmeterol ⁄ ﬂuticasone and the budesonide ⁄ formoterol groups (45% and 49.4% respectively) did not renew the prescription of their initial ICS ⁄ LABA combination. Costs Total mean asthma-related costs were signiﬁcantly greater for the salmeterol ⁄ ﬂuticasone group com- pared with the budesonide ⁄ formoterol group (Figure 4). The biggest differences were seen for asthma-related medications and asthma-related visits, for which costs were signiﬁcantly greater for the salmeterol ⁄ ﬂuticasone group than the budeso- nide ⁄ formoterol group. Mean costs associated with asthma-related referrals and hospitalisations were not signiﬁcantly different between treatment groups. A generalised linear model using a log-normal dis- tribution was used to estimate the effect of treatment on costs. When adjusting for covariates, budeso- nide ⁄ formoterol reduced total asthma-related costs ()13.4%: p < 0.001) compared with salmeterol ⁄ ﬂuticasone. Total cost, including both asthma-related (medication, visits, referrals and hospitalisations) and non-asthma-related (medications and visits) costs, was 17.1% lower for budesonide ⁄ formoterol com- pared with salmeterol ⁄ ﬂuticasone in the crude com- parison (683.57€ vs. 824.67€; p = 0.0001) and 12.6% lower in the adjusted analysis (p < 0.0001). Discussion Clinical studies have shown that for patients with asthma uncontrolled by low-dose ICS treatment, ﬁxed-dose combinations of an ICS and a LABA are Figure 4 Crude comparison of costs in the postindex year between salmeterol ⁄ ﬂuticasone- (white bars) and budesonide ⁄ formoterol- (black bars) treated patients. p-values were derived using an unequal variance t-test ª 2008 Ingenix Pharmaceutical Services (UK) Ltd. Journal compilation ª 2008 Blackwell Publishing Ltd Int J Clin Pract, December 2008, 62, 12, 1870–1879