Holzer S S, Engelhart L, Crown W H, L'Herrou T A, Kennedy S T
American Academy of Otolaryngology-Head and Neck Surgery Foundation, Washington DC, USA.
Am J Manag Care. 1997 Jun;3(6):891-7.
Asthma is a chronic inflammatory disorder of the airways that affects 10 to 17.5 million people and leads to more than $5 billion in treatment costs in the Unites States annually. This retrospective study is an initial step in understanding the beneficial economic outcomes of inhaled corticosteroid therapy by determining whether differences exist in healthcare utilization expenditures for three inhaled corticosteroids available for use in the United States: (1) beclomethasone dipropionate (Vanceril/Schering and Beclovent/Allan & Hanburys); (2) flunisolide (Aerobid/Forest); and (3) and triamcinolone acetonide (Azmacort/Rhône-Poulenc Rorer). This study was based on an analysis of 4,441 patients with at least one pharmaceutical claim for one of the study drugs, using inpatient, outpatient, and prescription drug claims data obtained from The MEDSTAT Group's MarketScan database for calendar years 1990 through 1993. We tested a null hypothesis for no differences in total asthma treatment costs, when drugs were excluded, using multivariate linear regression modeling controlling for patient demographic and clinical characteristics that might affect the study outcome. We found that, after excluding study drug payments and controlling for other contributing factors, total asthma healthcare expenditures to triamcinolone acetonide (Azmacort) users were higher than those for beclomethasone dipropionate (Vanceril and Beclovent) and flunisolide (Aerobid) users. When study drug costs were included in the expenditure measure, both triamcinolone acetonide (Azmacort) and flunisolide (Aerobid) users had higher expenditures than did beclomethasone dipropionate (Vanceril and Beclovent) users. No significant differences in expenditures were detected between Vanceril and Beclovent patients, a finding consistent with the fact that these drugs are the same type of inhaled corticosteroid. Other factors contributing to differences in total asthma healthcare costs included patient age, patterns of switching among and continuing with study drugs, prestudy asthma utilization or drug proxy severity, and comorbidities of precipitating illnesses.
哮喘是一种气道慢性炎症性疾病，在美国影响着1000万至1750万人，每年导致超过50亿美元的治疗费用。这项回顾性研究是了解吸入性糖皮质激素疗法有益经济结果的第一步，通过确定在美国可使用的三种吸入性糖皮质激素在医疗保健使用支出方面是否存在差异：（1）二丙酸倍氯米松（Vanceril/先灵葆雅公司和必可酮/艾伦汉伯里公司）；（2）氟尼缩松（Aerobid/福瑞斯特公司）；以及（3）曲安奈德（Azmacort/罗纳普朗克·罗瑞尔公司）。本研究基于对4441例至少有一项研究药物用药记录的患者的分析，使用了从MEDSTAT集团的MarketScan数据库获取的1990年至1993年历年的住院、门诊和处方药记录数据。我们使用多变量线性回归模型检验了一个零假设，即在排除药物后，哮喘总治疗成本不存在差异，该模型控制了可能影响研究结果的患者人口统计学和临床特征。我们发现，在排除研究药物费用并控制其他影响因素后，使用曲安奈德（Azmacort）的患者的哮喘医疗总支出高于使用二丙酸倍氯米松（Vanceril和必可酮）和氟尼缩松（Aerobid）的患者。当将研究药物成本纳入支出衡量指标时，使用曲安奈德（Azmacort）和氟尼缩松（Aerobid）的患者的支出均高于使用二丙酸倍氯米松（Vanceril和必可酮）的患者。在使用Vanceril和必可酮的患者之间未检测到支出的显著差异，这一发现与这些药物属于同一类吸入性糖皮质激素这一事实一致。导致哮喘医疗总成本差异的其他因素包括患者年龄、在研究药物之间切换和持续使用的模式、研究前哮喘的使用情况或药物替代严重程度，以及诱发疾病的合并症。
