Cost Effectiveness of Leukotriene Receptor Antagonists versus Inhaled Corticosteroids for Initial Asthma Controller Therapy: A Pragmatic Trial

Edward C. F. Wilson* (Corresponding Author), Erika J. Sims, Stanley D. Musgrave, Lee Shepstone, Annie Blyth, Jamie Murdoch, H. Miranda Mugford, Elizabeth F. Juniper, Jon G. Ayres, Stephanie Wolfe, Daryl Freeman, Richard F. T. Gilbert, Ian Harvey, Elizabeth V. Hillyer, David Price

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: Information is lacking on the relative effectiveness and cost effectiveness – in a primary-care setting – of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled corticosteroids (ICS) for initial asthma controller therapy.

Objective: To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy.

Methods: An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12–80 years with asthma and symptoms requiring regular anti-inflammatory therapy (n¿=¿326) were randomly assigned to LTRAs (n¿=¿162) or ICS (n¿=¿164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives.

Results: Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at £711 versus £433 for the ICS group (adjusted difference £204; 95% CI 74, 308) [year 2005 values]. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of -0.073 (95% CI -0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of £30¿000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives.

Conclusions: There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy.

Trial registration: UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
Original languageEnglish
Pages (from-to)585-595
Number of pages11
Publication statusPublished - 1 Jul 2010

Bibliographical note

The authors thank all the patients and their families for their participation and support during the study. We gratefully acknowledge the support and assistance of many who have helped this study, including GPs, nurses and administrative staff in the participating practices; Julie Houghton, Emma Koro, Sasha Rust-Andrews and Carole Bull of the research team; Dr Alistair Lipp for advice on study design and delivery; Dr Mark L. Levy (Clinical Research Fellow: Allergy and Respiratory Research Group, Division of Community Health Sciences, University of Edinburgh, Scotland) for advice on the initial study design and implementation; Jon Bell for advice on peak flow measurement; and Linda Kemp of Respiratory Research Ltd for assistance with the analyses.

This project was funded by the Health Technology Assessment Programme (project number 98/34/05). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health (UK). Additional support was provided for the implementation of the study from Clement-Clarke International and by unrestricted educational grants from Merck Sharpe and Dohme Ltd, AstraZeneca Ltd and Research in Real Life Ltd who contributed 9% of the total budget.

For a list of the contributions of the authors to the study and their conflicts of interest, see the Supplemental Digital Content 2,


  • Asthma
  • Fluticasone Propionate
  • Montelukast
  • Zafirlukast
  • Supplemental Digital Content


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