Costs and Resource Use of Mild Persistent Asthma Patients Initiated on Controller Therapy

Abstract

In this analysis, physicians, despite guideline recommendations, chose to treat patients with mild persistent asthma more often with LM and ICS+LABA than with ICS. However, therapy with ICS was less costly than treatment with either LM or ICS+LABA, primarily due to differences in drug costs, and provided similar outcomes.

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma

“…8 Used sequentially, the HEDIS and Leidy criteria effectively identify persistent asthma patients. 5,8,10 Relying on patterns of medication use to categorize patients as having moderate and severe persistent asthma is consistent with GINA guidelines. 18 Use of oral corticosteroids, a commonly used indicator of asthma exacerbations, for acute sinusitis is unlikely to explain differences between the 2 populations because the exacerbation group also had more asthma-related ED visits, hospitalizations, and outpatient visits.…”

“…9 The effect that asthma exacerbations have on health care costs among patients with moderate and severe persistent asthma has not been quantified. We used a previously established algorithm 5,8,10 to identify patients with moderate and severe persistent asthma from a large claims database and evaluated the effect of exacerbations on resource use and health care costs. We hypothesized that exacerbations would increase health care costs in patients with moderate and severe persistent asthma.…”

Asthma Severity Categorization Using a Claims-Based Algorithm or Pulmonary Function Testing

“…Persistent asthma patients were identified from the database by a two-step process using medical and pharmacy utilization data over the 1 year before the index date (4,9,10). The first step used the Health Plan Employer Data and Information Set (HEDIS) criteria, which identify patients with persistent asthma as those having four or more asthma medication dispensing events; 1 or more acute inpatient discharge(s) with a primary diagnosis of asthma; 1 or more ED visit(s) with a primary diagnosis of asthma; or 4 or more outpatient visits with asthma listed anywhere as one of the diagnoses and 2 or more asthma medication dispensing (14).…”

“…Patients with more severe asthma generate greater health care costs than those with mild and moderate disease (6)(7)(8). Strategies aimed at more effectively providing care in large groups across the entire spectrum of asthma severity might both improve outcomes and reduce costs (9,10).…”

Surveillance of the cost of asthma in the 21st century

“…8 Other work has found treating mild persistent asthma with combination products as opposed to guideline-recommended ICSs does not improve outcomes but does increase cost. 9 We need to refine our tracking data on medical expenditures to monitor that the level of medication prescribed matches the level of severity to avoid unnecessary costs.…”