1 University of Wisconsin, Madison.
2 U.S. Medical Affairs; New Therapeutic Areas, Genentech, South San Francisco, California.
J Manag Care Spec Pharm. 2017 Nov;23(11):1117-1124. doi: 10.18553/jmcp.2017.23.11.1117.
The Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for asthma include the asthma medication ratio (AMR) as a marker of quality of care for patients with asthma. Few data are available to describe the association between health care use and costs in patients with high versus low AMR.
To characterize health care use and costs associated with high versus low AMR in patients participating in commercial health plans.
In a commercial claims database, this study retrospectively identified patients aged 5 to 64 years on December 31, 2011, who met the HEDIS definition of asthma in the premeasurement year (January 1, 2010-December 31, 2010) and the measurement year (January 1, 2011-December 31, 2011). Each patient was classified as having either high or low AMR based on the HEDIS definition. AMR was calculated as the ratio of controller to total asthma medications; high AMR was defined as ≥ 0.5. Annual per-patient health care use and costs were compared in patients with high versus low AMR using (a) multivariable linear regression models to estimate mean annual number of office visits, oral corticosteroids (OCS) bursts (≤ 15-day supply), and costs and (b) negative binomial models to estimate mean annual hospitalization and emergency department (ED) visits. All estimates were adjusted for age, sex, region, and Charlson Comorbidity Index score to control for differences between patients with high versus low AMR.
Patients were identified with high (30,575) and low (6,479) AMR. An average patient with high AMR had more all-cause office visits (14.1 vs. 11.0; P < 0.001), fewer all-cause hospitalizations (0.109 vs. 0.215; P < 0.001), fewer all-cause ED visits (0.321 vs. 0.768; P < 0.001), and fewer OCS bursts (0.83 vs. 1.33; P < 0.001) than an average patient with low AMR. An average patient with high AMR had fewer asthma-related hospitalizations (0.024 vs. 0.088; P < 0.001) and ED visits (0.060 vs. 0.304; P < 0.001) than an average patient with low AMR. Numbers of asthma-related annual office visits were similar between the high and low AMR groups (high 2.2 vs. low 2.2; not significant). The rate of poor asthma control events (≥ 6 short-acting beta-agonist dispensing events or ≥ 2 OCS bursts, asthma-related ED visits, or hospitalizations) was greater in patients with low AMR than in patients with high AMR (74.3% vs. 26.9%). An average patient with high AMR had lower annual nonmedication costs than an average patient with low AMR ($5,733 vs. $6,295; P = 0.011). Similar trends emerged for asthma-related costs. A patient with high AMR had higher average total annual health care costs than a patient with low AMR ($9,811 vs. $8,398; P < 0.001). These increased costs primarily resulted from increased medication costs for patients with high versus low AMR ($4,077 vs. $2,103; P < 0.001).
Although patients with high AMR had more office visits and higher medication (which resulted in higher overall health care) costs, their care was marked by fewer OCS bursts (indicating fewer instances of poor asthma control), fewer ED visits, and fewer hospitalizations and lower non-medication costs than those patients with low AMR. These findings support the use of AMR as a care quality measure for patients with persistent asthma.
This study was funded by Genentech. Luskin has received consulting and lecture fees, research and travel support, and payment for developing educational presentations from Genentech and has received lecture fees from Merck. Raimundo and Solari are employees of Genentech. Antonova was employed by Genentech at the time of this study. Broder and Chang are employees of Partnership for Health Analytic Research, which received funding from Genentech to conduct this research. Study concept and design were contributed by all authors. Broder and Chang conducted analyses. All authors interpreted the data. Antonova wrote the manuscript with assistance from the other authors. All authors participated in manuscript review and revisions.
医疗效果数据和信息集（HEDIS）的哮喘质量指标包括哮喘药物比率（AMR），作为哮喘患者护理质量的指标。关于高 AMR 与低 AMR 患者的医疗保健使用和成本之间的关联，可用的数据很少。
描述在参加商业健康计划的患者中，高 AMR 与低 AMR 患者的医疗保健使用和成本的关联。
在商业索赔数据库中，本研究回顾性地确定了 2011 年 12 月 31 日年龄在 5 至 64 岁之间的患者，他们在测量年度（2011 年 1 月 1 日至 2011 年 12 月 31 日）和预测量年度（2010 年 1 月 1 日至 2010 年 12 月 31 日）满足 HEDIS 对哮喘的定义。根据 HEDIS 的定义，每位患者分为高 AMR 或低 AMR。AMR 通过将控制器与总哮喘药物的比值计算得出；高 AMR 定义为≥0.5。使用（a）多变量线性回归模型估计门诊就诊次数、口服皮质类固醇（OCS）发作次数（≤15 天供应量）和费用的年度每位患者的医疗保健使用和成本，以及（b）负二项模型估计每年住院和急诊就诊次数，比较高 AMR 与低 AMR 患者的医疗保健使用和成本。所有估计值均根据年龄、性别、地区和 Charlson 合并症指数评分进行调整，以控制高 AMR 与低 AMR 患者之间的差异。
确定了高（30575）和低（6479）AMR 的患者。平均高 AMR 患者的全因门诊就诊次数更多（14.1 次比 11.0 次；P<0.001），全因住院次数更少（0.109 次比 0.215 次；P<0.001），全因急诊就诊次数更少（0.321 次比 0.768 次；P<0.001），OCS 发作次数更少（0.83 次比 1.33 次；P<0.001），比低 AMR 患者平均水平低。平均高 AMR 患者的哮喘相关住院次数（0.024 次比 0.088 次；P<0.001）和急诊就诊次数（0.060 次比 0.304 次；P<0.001）比低 AMR 患者少。高 AMR 与低 AMR 组的哮喘相关年度门诊就诊次数相似（高 AMR 2.2 次比低 AMR 2.2 次；无显著差异）。低 AMR 患者的哮喘控制不良事件发生率（≥6 次短效β激动剂配药事件或≥2 次 OCS 发作、哮喘相关急诊就诊或住院）高于高 AMR 患者（74.3%比 26.9%）。高 AMR 患者的年度非药物治疗费用低于低 AMR 患者（$5733 比 $6295；P=0.011）。哮喘相关成本也出现了类似的趋势。高 AMR 患者的总年度医疗保健费用高于低 AMR 患者（$9811 比 $8398；P<0.001）。这些增加的成本主要是由于高 AMR 患者的药物费用增加，而高 AMR 患者的药物费用比低 AMR 患者高（$4077 比 $2103；P<0.001）。
尽管高 AMR 患者的门诊就诊次数和药物（这导致了更高的整体医疗保健）费用更高，但他们的护理以较少的 OCS 发作（表明哮喘控制不良的情况较少）、较少的急诊就诊次数和较少的住院次数为特征，并且非药物治疗费用也低于低 AMR 患者。这些发现支持将 AMR 用作持续性哮喘患者的护理质量指标。
本研究由 Genentech 资助。Luskin 已从 Genentech 获得咨询和演讲费、研究和旅行支持以及制定教育演示文稿的报酬，并从 Merck 获得演讲费。Raimundo 和 Solari 是 Genentech 的员工。Antonova 在进行这项研究时受雇于 Genentech。Broder 和 Chang 受雇于 Partnership for Health Analytic Research，该公司从 Genentech 获得资金进行这项研究。所有作者均对研究概念和设计做出了贡献。Broder 和 Chang 进行了分析。所有作者均解释了数据。Antonova 在其他作者的协助下撰写了手稿。所有作者均参与了手稿的审查和修订。
