Out-of-Pocket Spending for Asthma-Related Care Among Commercially Insured Patients, 2004-2016

Sinaiko, Anna D.; Gaye, Marema; Wu, Ann Chen; Bambury, Elizabeth; Zhang, Fang; Xu, Xin; Wharam, J. Frank; Galbraith, Alison A.

doi:10.1016/j.jaip.2021.07.054

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…A recent report showed higher out-of-pocket spending on inpatient and emergency health care among low-income patients with asthma. 25 We observed a significant decrease in ER and office visits and corticosteroid prescriptions for asthma exacerbations after patients started biologic treatment, emphasizing the importance of a quick and efficient approval process.…”

Section: Discussionmentioning

confidence: 87%

Elaborate biologic approval process delays care of patients with moderate-to-severe asthma

Sehanobish

Imam

et al. 2023

Journal of Allergy and Clinical Immunology: Global

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Section: Discussionmentioning

confidence: 87%

Elaborate biologic approval process delays care of patients with moderate-to-severe asthma

Sehanobish

Imam

et al. 2023

Journal of Allergy and Clinical Immunology: Global

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“… 24 25 Furthermore, it is known that lower-income patients spend less on (costly) controller medications (eg, ICS and ICS-LABA), which causes rescue medications (ie, systemic steroids) to represent a larger proportion of the total drug use. 26 In line with GOLD guidelines, in the other databases (except for AUSOM in South Korea) initial treatment of adults with COPD consisted of a bronchodilator, either short acting or long acting. 7 The choice of bronchodilator depends on the number of previous COPD exacerbations and symptom control.…”

Section: Discussionmentioning

confidence: 99%

Real-world treatment trajectories of adults with newly diagnosed asthma or COPD

Markus,

Rijnbeek,

Kors

et al. 2024

BMJ Open Resp Res

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BackgroundThere is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice.MethodsThis retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots.ResultsIn four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%–47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%–33.2% for asthma and 27.0%–52.2% for COPD) from the USA as compared with EHR databases (6.9%–15.2% for asthma and 4.4%–17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments.ConclusionReal-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients’ needs.

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“…Health plans with a PDL are more generous than those without, and employees may pay higher premiums to account for additional costs of these plans, which we cannot observe in our data. OOP asthma costs represent a more substantial portion of income for patients with lower income . However, the magnitudes of the observed outcomes were similar for patients in both high and low-income neighborhoods.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Spending With Preventive Drug Lists for Asthma Medications in High-Deductible Health Plans

Sinaiko,

Ross-Degnan,

Wharam

et al. 2023

JAMA Netw Open

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ImportanceHigh-deductible health plans with health savings accounts (HDHP-HSAs) incentivize patients to use less health care, including necessary care. Preventive drug lists (PDLs) exempt high-value medications from the deductible, reducing out-of-pocket cost sharing; the associations of PDLs with health outcomes among patients with asthma is unknown.ObjectiveTo evaluate the associations of a PDL for asthma medications on utilization, adverse outcomes, and patient spending for HDHP-HSA enrollees with asthma.Design, Setting, and ParticipantsThis case-control study used matched groups of patients with asthma before and after an insurance design change using a national commercial health insurance claims data set from 2004-2017. Participants included patients aged 4 to 64 years enrolled for 1 year in an HDHP-HSA without a PDL in which asthma medications were subject to the deductible who then transitioned to an HDHP-HSA with a PDL that included asthma medications; these patients were compared with a matched weighted sample of patients with 2 years of continuous enrollment in an HDHP-HSA without a PDL. Models controlled for patient demographics and asthma severity and were stratified by neighborhood income. Analyses were conducted from October 2020 to June 2023.ExposuresEmployer-mandated addition of a PDL that included asthma medications to an existing HDHP-HSA.Main Outcomes and MeasuresOutcomes of interest were utilization of asthma medications on the PDL (controllers and albuterol), asthma exacerbations (oral steroid bursts and asthma-related emergency department use), and out-of-pocket spending (all and asthma-specific).ResultsA total of 12 174 participants (mean [SD] age, 36.9 [16.9] years; 6848 [56.25%] female) were included in analyses. Compared with no PDL, PDLs were associated with increased rates of 30-day fills per enrollee for any controller medication (change, 0.10 [95% CI, 0.03 to 0.17] fills per enrollee; 12.9% increase) and for combination inhaled corticosteroid long-acting β2-agonist (ICS-LABA) medications (change, 0.06 [95% CI, 0.01 to 0.10] fills per enrollee; 25.4% increase), and increased proportion of days covered with ICS-LABA (6.0% [0.7% to 11.3%] of days; 15.6% increase). Gaining a PDL was associated with decreased out-of-pocket spending on asthma care (change, −$34 [95% CI, −$47 to −$21] per enrollee; 28.4% difference), but there was no significant change in asthma exacerbations and no difference in results by income.Conclusions and RelevanceIn this case-control study, reducing cost-sharing for asthma medications through a PDL was associated with increased adherence to controller medications, notably ICS-LABA medications used by patients with more severe asthma, but was not associated with improved clinical outcomes. These findings suggest that PDLs are a potential strategy to improve access and affordability of asthma care for patients in HDHP-HSAs.

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Out-of-Pocket Spending for Asthma-Related Care Among Commercially Insured Patients, 2004-2016

Cited by 12 publications

References 20 publications

Elaborate biologic approval process delays care of patients with moderate-to-severe asthma

Elaborate biologic approval process delays care of patients with moderate-to-severe asthma

Real-world treatment trajectories of adults with newly diagnosed asthma or COPD

Utilization and Spending With Preventive Drug Lists for Asthma Medications in High-Deductible Health Plans

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