Ye Xin, Gutierrez Benjamin, Zarotsky Victoria, Nelson Michael, Blanchette Christopher M
i3 Innovus, Eden Prairie, MN, USA.
Curr Med Res Opin. 2009 Sep;25(9):2251-8. doi: 10.1185/03007990903155915.
To examine health care utilization measures indicating which asthma patients are appropriate for inhaled corticosteroid and long-acting beta(2)-adrenergic agonist (ICS/LABA) therapy and determine whether two ICS/LABA therapies were initiated in accordance with guidelines.
A retrospective cohort study of commercially insured asthma patients aged > or =12 years that initiated fluticasone propionate/salmeterol (FSC) or budesonide/formoterol fumarate dihydrate (BFC) combination therapy in 2007 was conducted. Use was considered appropriate if patients met any of the following during a 1-year period before ICS/LABA initiation: ICS or leukotriene receptor antagonist (LTRA) use; an asthma-related emergency department (ED) visit or hospitalization; > or =2 oral corticosteroids (OCS) courses; or > or =6 short-acting beta(2)-adrenergic agonist (SABA) canisters. Multivariate logistic regression was used to assess factors associated with appropriate ICS/LABA use. Certain limitations inherent to the use of claims data for research apply to this study.
Of 24,231 patients who initiated ICS/LABA therapy, 993 received BFC and 23,238 received FSC. Among all patients, 37.6% met > or =1 criteria for appropriate use. However, compared with FSC users, BFC users had a significantly higher likelihood of meeting > or =1 of these criteria (odds ratio, 2.01; 95% CI, 1.76-2.30; p < 0.001), and a higher proportion of BFC than FSC patients met 4 of the 5 appropriate use criteria. In total, 58.4% of BFC patients versus 36.7% of FSC patients met > or =1 criteria for appropriate use. Other factors associated with appropriate use included age, region, Charlson comorbidity score, number of medications, and prescriber specialty.
Fewer than half of all patients fulfilled the specified criteria for being appropriate for ICS/LABA therapy. However, a significantly higher proportion of BFC than FSC users met the criteria for appropriate use of ICS/LABA therapy. These results may suggest a need for improved physician awareness of consensus guidelines for the initiation of ICS/LABA therapy.
研究医疗保健利用指标，以确定哪些哮喘患者适合吸入性糖皮质激素和长效β2肾上腺素能激动剂（ICS/LABA）治疗，并确定两种ICS/LABA治疗是否按照指南启动。
对2007年开始使用丙酸氟替卡松/沙美特罗（FSC）或布地奈德/富马酸福莫特罗二水合物（BFC）联合治疗的12岁及以上商业保险哮喘患者进行回顾性队列研究。如果患者在开始ICS/LABA治疗前的1年期间符合以下任何一项，则认为使用是适当的：使用ICS或白三烯受体拮抗剂（LTRA）；因哮喘到急诊科（ED）就诊或住院；≥2个口服糖皮质激素（OCS）疗程；或≥6个短效β2肾上腺素能激动剂（SABA）吸入器。使用多因素逻辑回归分析评估与适当使用ICS/LABA相关的因素。本研究存在使用索赔数据进行研究固有的某些局限性。
在开始ICS/LABA治疗的24231例患者中，993例接受了BFC治疗，23238例接受了FSC治疗。在所有患者中，37.6%符合≥1项适当使用标准。然而，与FSC使用者相比，BFC使用者符合≥1项这些标准的可能性显著更高（优势比，2.01；95%CI，1.76 - 2.30；p < 0.001），并且符合5项适当使用标准中的4项的BFC患者比例高于FSC患者。总体而言，58.4%的BFC患者和36.7%的FSC患者符合≥一项适当使用标准。与适当使用相关的其他因素包括年龄、地区、查尔森合并症评分、药物数量和开处方者专业。
所有患者中不到一半符合ICS/LABA治疗的指定适当标准。然而，符合ICS/LABA治疗适当使用标准的BFC使用者比例显著高于FSC使用者。这些结果可能表明需要提高医生对ICS/LABA治疗启动共识指南的认识。
