Asthma costs and utilization in a managed care organization - 15/08/11
, Joel W. Hay, PhD b, Richard Contreras, MS a, Wansu Chen, MS a, Virginia P. Quinn, PhD a, Brian Seal, PhD, MBA c, Michael Schatz, MD, MS a
Reprint requests: Robert S. Zeiger, MD, PhD, Director of Allergy Research, Department of Allergy, Kaiser Permanente Medical Center, 7060 Clairemont Mesa Blvd, San Diego, CA 92111.Abstract |
Background |
Medical costs and health care utilization associated with asthma and the variation by treatment are poorly understood.
Objective |
To compare single controller inhaled corticosteroid (ICS) to other asthma drug regimens on medical costs and utilization.
Methods |
Direct medical costs and utilization were captured from administrative electronic databases from continuously enrolled members with asthma age 5 years or older with drug coverage. Asthma patients were identified during 2002, categorized into 14 asthma drug groups on the basis of 2003 prescription records, and had total medical costs and utilization determined in 2004 adjusting for demographics, insurance types, asthma risk, comorbidity, and propensity scores.
Results |
A total of 96,631 patients met the study eligibility criteria. Patients were (mean ± SD) age 38 ± 23 years and were 57% female, 14% Medicare, 4% Medicaid, and had a median family income (mean ± SD) of $64,967 ± $29,285. Total unadjusted direct medical costs/patient/year averaged $3745 ($3298 low asthma risk vs $6797 high asthma risk; P < .001). Adjusted total and asthma drug costs were significantly lower with single controller ICS compared with single controller leukotriene modifiers, long-acting β-agonists, and theophylline and most combination controller regimens (P < .001 for all comparisons). In addition, single controller ICS compared with single controller leukotriene modifiers and combination controllers was associated with significantly lower asthma-related utilization.
Conclusion |
Total direct costs and asthma-related utilizations are meaningfully less in the year after being dispensed single controller ICS compared with single controller leukotriene modifiers or most combination controllers.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, combination controllers, drugs, health care costs, inhaled corticosteroids, leukotriene modifiers, long-acting β-agonists, managed care organization, health resource utilization
Abbreviations used : COPD, ED, ICD-9, ICS, ITT, KPSC, LABA, LM, MCO, MCS, SABA
Plan
| Supported by an investigational grant to the Southern California Permanente Medical Group Research and Evaluation Department from Sanofi-Aventis Pharmaceuticals. The protocol was developed by the Kaiser Permanente Southern California and University of Southern California research group. A health economist from the sponsor provided input during protocol development. The sponsor approved the protocol with only minor suggestions. Data collection, extraction, and analysis were performed by Kaiser Permanente Southern California. The manuscript was written entirely without sponsor involvement. The sponsor approved the manuscript without requesting any modifications. |
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| Disclosure of potential conflict of interest: R. S. Zeiger has consulting arrangements with Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, Merck, Novartis, Sanofi-Aventis, and Schering-Plough and has received research support from AstraZeneca, Genentech, GlaxoSmithKline, Merck, Sanofi-Aventis, and Teva Pharmaceuticals. J. W. Hay has consulting arrangements with and has received research support from Sanofi-Aventis. V. P. Quinn has received research support from the National Institutes of Health, Sanofi-Aventis, and GlaxoSmithKline. B. Seal is employed by and owns stock in Sanofi-Aventis. M. Schatz has consulting arrangements with GlaxoSmithKline; has received research support from Sanofi-Aventis, GlaxoSmithKline, and Schering-Plough; and has received honoraria for talks from GlaxoSmithKline, Genentech, and Merck. The rest of the authors have declared that they have no conflict of interest. |
Vol 121 - N° 4
P. 885 - avril 2008 Retour au numéro
Article précédent
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