Hines VA Hospital, University of Illinois at Chicago, Chicago, IL, USA.
Curr Med Res Opin. 2010 Dec;26(12):2851-60. doi: 10.1185/03007995.2010.531255. Epub 2010 Nov 12.
To compare asthma-related resource utilization, adherence and costs among adults prescribed asthma controller regimens.
Medical and pharmacy claims from a US managed-care claims database were used to identify adults (18-56 years) initiating asthma controller therapy. Patients had 2 years continuous enrollment and ≥ 1 medical claims for asthma (ICD9: 493.xx) (January 2004 - March 2009). Asthma exacerbations, short-acting β-agonist (SABA) fills, adherence (MPR ≥ 0.80) and asthma-related costs were assessed for 1 year after the initial asthma controller medication claim. Separate logistic and negative binomial regression models for monotherapy and combination therapy were developed to examine the impact of controller therapy on outcomes.
A total of 28 074 patients [inhaled corticosteroids (ICS) (26.3%), leukotriene modifiers (LM) (23.2%), ICS + long acting β-agonist (LABA) (48.5%), ICS + LM (2%)] were included. LM patients had lower odds of ≥ 6 SABA fills (OR(adj) = 0.83, 95% CI: 0.73-0.96) and lower rates of asthma exacerbations (RR(adj) = 0.82, 0.75-0.89) vs. ICS patients. Odds of ≥ 6 SABA fills were similar for ICS + LM vs. ICS + LABA (OR(adj) = 1.3, 0.96-1.76); the rate of asthma exacerbations was greater for ICS + LM compared with ICS + LABA (OR(adj) = 1.4, 1.2-1.6). The proportion adherent was greatest for LM (14.9%) and ICS + LABA (4.1%). LM patients had higher unadjusted pharmacy costs, but lower medical costs compared to ICS patients. For combination therapy, ICS + LM had higher unadjusted mean medical and pharmacy costs vs. ICS + LABA. Higher adjusted mean total costs in the post-index period were observed for LM vs. ICS patients ($837 vs. 684) and for ICS + LM vs. ICS + LABA patients ($1223 vs. 873).
LM monotherapy was associated with lower medical costs but higher total costs resulting from greater treatment adherence. Conversely, higher costs for ICS + LM resulted from greater exacerbations compared to ICS + LABA despite similar adherence. Higher total costs with LM were due to drug costs. Precise utilization of the medications filled by patients could not be determined.
比较开具哮喘控制药物的成年人中与哮喘相关的资源利用、依从性和成本。
使用美国管理式医疗索赔数据库中的医疗和药房索赔数据，确定开始哮喘控制药物治疗的成年人（18-56 岁）。患者有 2 年连续入组和≥1 次哮喘（ICD9：493.xx）的医疗索赔（2004 年 1 月-2009 年 3 月）。在初始哮喘控制药物索赔后 1 年评估哮喘加重、短效β激动剂（SABA）用量、依从性（MPR≥0.80）和哮喘相关成本。为单药治疗和联合治疗分别开发了逻辑回归和负二项回归模型，以研究控制药物对结果的影响。
共纳入 28074 例患者[吸入皮质激素（ICS）（26.3%）、白三烯调节剂（LM）（23.2%）、ICS+长效β激动剂（LABA）（48.5%）、ICS+LM（2%）]。与 ICS 患者相比，LM 患者使用≥6 次 SABA 的可能性较小（调整后 OR（adj）=0.83，95%CI：0.73-0.96），哮喘加重的发生率较低（调整后 RR（adj）=0.82，0.75-0.89）。ICS+LM 患者使用≥6 次 SABA 的可能性与 ICS+LABA 相似（调整后 OR（adj）=1.3，0.96-1.76）；ICS+LM 患者哮喘加重的发生率高于 ICS+LABA（调整后 OR（adj）=1.4，1.2-1.6）。LM（14.9%）和 ICS+LABA（4.1%）的依从性最高。LM 患者的未调整药房成本较高，但医疗成本低于 ICS 患者。对于联合治疗，ICS+LM 的未调整平均医疗和药房成本高于 ICS+LABA。在索引后期间观察到 LM 比 ICS 患者（837 美元比 684 美元）和 ICS+LM 比 ICS+LABA 患者（1223 美元比 873 美元）的总调整后平均成本更高。
LM 单药治疗与较低的医疗成本相关，但由于更高的治疗依从性导致总成本更高。相反，与 ICS+LABA 相比，尽管依从性相似，但 ICS+LM 导致更高的加重率，导致更高的成本。ICS+LM 更高的总成本归因于药物成本。不能确定患者所开药物的使用情况。
