Inhaled Corticosteroid Claims and Outpatient Visits After Hospitalization for Asthma Among Commercially Insured Children

Andrews, Annie Lintzenich; Bundy, David G.; Simpson, Kit N.; Teufel, Ronald J.; Harvey, Jillian; Simpson, Annie N.

doi:10.1016/j.acap.2016.10.016

Cited by 12 publications

(6 citation statements)

References 26 publications

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“…This has also been seen in previous studies in which ICS prescription filling among pediatric patients with commercial insurance is assessed. 26 Asthma controller medication fill rates were similar to those seen by outpatient prescribers and outpatient specialty prescribers in other studies. 27,28 It is unclear whether this reflects true nonadherence or discontinuation of therapy by outpatient providers due to improved asthma control.…”

Section: Discussionsupporting

confidence: 82%

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Molina¹,

Magruder²,

Aban

et al. 2019

Hospital Pediatrics

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A B S T R A C TBACKGROUND: Asthma is a common cause of pediatric hospitalization. Nonadherence to asthma medications is associated with worse outcomes; however, there is a paucity of data regarding posthospitalization prescription filling and hospital reuse. Our objective was to identify patients at risk for hospital reuse after being hospitalized for asthma.METHODS: This is a retrospective study of patients with asthma who were discharged from a children's hospital in which we use Medicaid claims data to evaluate prescription fills within 30 days and 12 months. Chart reviews were used for demographics, chronic asthma severity, admission severity, and hospital reuse. t and x 2 tests were performed for continuous and categorical variables. A generalized linear mixed model was fitted to predict the odds of hospital reuse, which was defined as requiring an emergency department visit or rehospitalization. Survival analysis using log-rank testing was used for modeling the time to hospital reuse. RESULTS:Fifty-four percent of patients discharged with asthma had hospital reuse within 1 year of discharge. There was no association between hospital reuse and prescription filling for systemic steroids (odds ratio [OR] 1.30; confidence interval [CI]: 0.85-2.00; P 5 .21) or controller medications (OR 1.5; CI: 0.92-2.52; P 5 .10). There was a higher number of controller and systemic steroid prescription fills over 12 months for patients with hospital reuse. The factors associated with greater odds of hospital reuse were severity of chronic asthma diagnosis (P 5 .03) as well as African American race (OR 1.92; CI: 1.17-3.13; P 5 .01). CONCLUSIONS:For Medicaid-insured patients discharged with asthma, worse chronic asthma severity and African American race were associated with greater odds of hospital reuse. Decreased prescription filling was not associated with greater odds of hospital reuse.

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Section: Discussionsupporting

confidence: 82%

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Molina¹,

Magruder²,

Aban

et al. 2019

Hospital Pediatrics

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“…24 Our results (in a highly adherent population) highlight the potentially confounding effects of ICS on phenotype-outcome associations and argue for more rigorous assessment of ICS adherence in future studies, given that real-world adherence to these medications is typically poor, with <40% of patients taking these medications daily as prescribed. 53 The multi-center design of the studies included in our latent class analysis was another strength. Compared to other single-center studies, our analysis had good geographic representation across the United States with a relatively high-prevalence of underrepresented minorities.…”

Section: Discussionmentioning

confidence: 99%

Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation

AsthmaNet

2019

The Journal of Allergy and Clinical Immunology: In Practice

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Background-Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes. Objective-Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response. Methods-Data from five clinical trials of 1,708 children age 12-71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes. Results-Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (p < 0.001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups. Conclusion-Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.

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“…[ 14 , 15 ] These databases provide detailed data for analyses of costs, resource use, and outcomes research. [ 16 – 18 ] However, given that these are administrative claims databases, clinical data from which to directly estimate factors like treatment response were not available. All data were de-identified and compliant with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.…”

Section: Methodsmentioning

confidence: 99%

Treatment patterns and costs of care for patients with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin in the United States: A retrospective cohort study

Szabo¹,

Hirji

Johnston³

et al. 2017

PLoS ONE

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ObjectivesAlthough brentuximab vedotin (BV) has changed the management of patients with relapsed or refractory Hodgkin lymphoma (RRHL), little information is available on routine clinical practice. We identified treatment patterns and costs of care among RRHL patients in the United States (US) treated with BV.MethodsA retrospective observational study of adults initiating BV for RRHL from 2011–2015, with ≥6 months of data prior to and following BV initiation, was conducted. Treatments were classified based on dispensations and chemotherapy administration. Median total and monthly costs were estimated based on all-cause healthcare resource use in 2015 US dollars (USD).ResultsThe cohort comprised 289 patients (59% male; mean age at diagnosis, 42 years) with a mean follow-up of 250 weeks. Eleven percent had BV salvage therapy prior to ASCT, and 32% had BV for a relapse post-ASCT. 43% received treatment post-BV, most commonly allogeneic stem cell transplant (SCT) and bendamustine (both 10.2%). Median (IQR) total costs from BV initiation to censoring were 294,790 (142,110–483,360) USD; and were highest among those treated with BV prior to ASCT (up to 421,900 [300,940–778,970] USD). Median monthly costs were almost 20,000 USD per month, and up to 25,000 USD per month among those with BV and ASCT. Medications were the greatest driver of median monthly costs.ConclusionsMedian total all-cause costs were almost 300,000 USD, and median monthly costs approximately 20,000 USD, per patient treated. Patients requiring treatment following BV continue to incur high costs, highlighting the economic burden associated with managing patients in the RRHL setting.

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Inhaled Corticosteroid Claims and Outpatient Visits After Hospitalization for Asthma Among Commercially Insured Children

Cited by 12 publications

References 26 publications

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus

Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation

Treatment patterns and costs of care for patients with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin in the United States: A retrospective cohort study

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