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Outcomes and costs of patients with persistent asthma treated with beclomethasone dipropionate hydrofluoroalkane or fluticasone propionate

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Abstract

Objective

Examine outcomes and costs of patients with persistent asthma who initiated treatment with beclomethasone dipropionate hydrofluoroalkane (BDP-HFA) or fluticasone propionate (FP).

Methods

MedStat’s Commercial Claims and Encounters database (July 1, 2002–June 30, 2007) was utilized. Patients (n=13,968) were included if they initiated treatment with BDP-HFA or FP (first use=index date). Patients also met these criteria: (a) no receipt of other study medication in the 1-year post-period; (b) persistent asthma in the 1-year pre-period; (c) age 5–64 years; (d) no diagnosis of chronic obstructive pulmonary disease; and (e) continuous insurance coverage from 1 year pre-period to 1 year post-period. Multivariate regressions examined the probability of an ER visit or hospitalization, probability of reaching alternative adherence thresholds, and costs.

Results

Receipt of BDP-HFA, compared with FP, was associated with a 17% reduction in the odds of an ER visit (OR=0.834, 95% CI 0.751 to 0.925), a 30% reduction in the odds of an asthma-related ER visit (OR=0.697, 95% CI 0.571 to 0.852), and an increase in the odds of obtaining a medication possession ratio (MPR) of at least 50% (OR=1.324; 95% CI 1.164 to 1.506) or 75% (OR=1.311; 95% CI 1.072 to 1.604). Total medical costs ($5063 vs. $5377, P=0.0042), prescription drug costs ($2336 vs. $2581, P<0.0001), and ER costs ($185 vs. $249, P<0.0001) were significantly lower among the BDP-HFA cohort. Asthma-related outpatient ($191 vs. $224, P<0.0001) and ER costs ($28 vs. $45, P<0.001) were significantly lower in the BDP-HFA group, while asthma-related inpatient ($101 vs. $59, P<0.0001) and drug costs ($451 vs. $540, P<0.0001) were significantly lower in the FP cohort.

Conclusions

Results indicate that receipt of BDP-HFA, compared with receipt of FP, is associated with a decreased probability of ER visits or asthma-related ER visits and higher odds of reaching a medical possession ratio threshold of 50% or 75%. Receipt of BDP-HFA was also associated with lower total drug costs and lower total medical costs.

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References

  1. Asthma and Allergy Foundation of America website. Asthma facts and figures. Available at: http://www.aafa.org. Accessed December 11, 2008.

  2. National Center for Health Statistics, Centers for Disease Control. Asthma Prevalence, Health Care Use and Mortality: United States, 2003-05. Published November 2006. Last reviewed October 15, 2008. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm. Accessed December 11, 2008.

  3. Moorman JE, Rudd RA, Johnson CA, et al. National Surveillance for Asthma-United States, 1980-2004. MMWR Surveillance Summaries. 2007;56(SS08):1–14;18–54. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm. Accessed July 15, 2009.

    Google Scholar 

  4. Ford ES, Mannino DM, Homa DM, et al. Self reported asthma and health-related quality of life: findings from the behavioral risk factor surveillance system. Chest. 2003;123:119–127.

    Article  PubMed  Google Scholar 

  5. Markovitz BP, Andresen EM. Lack of insurance coverage and urgent care use for asthma: a retrospective cohort study. BMC Public Health. 2006;6:14.

    Article  PubMed  Google Scholar 

  6. Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med. 1997;156:787–793.

    PubMed  CAS  Google Scholar 

  7. Cisternas MG, Blanc PD, Yen IH, et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003;111:1212–1218.

    Article  PubMed  Google Scholar 

  8. Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Dis. 2005;2:A11.

    PubMed  Google Scholar 

  9. Chapman KR. Impact of “mild” asthma on health outcomes: findings of a systematic search of the literature. Respir Med. 2005;99:1350–1362.

    Article  PubMed  CAS  Google Scholar 

  10. Colice G, Wu EQ, Birnbaum H, Daher M, Marynchenko MB, Varghese S. Healthcare and workloss costs associated with patients with persistent asthma in a privately insured population. J Occup Environ Med. 2006;48:794–802.

    Article  PubMed  CAS  Google Scholar 

  11. Colice G, Wu EQ, Birnbaum H, Daher M, Marynchenko MB. Use of inhaled corticosteroids and health care costs in mild persistent asthma. J Asthma. 2007;44:479–483.

    Article  PubMed  CAS  Google Scholar 

  12. Serra-Batlles J, Plaza V, Morejon E, Comella A, Brugues J. Costs of asthma according to the degree of severity. Eur Respir J. 1998;12:1322–1326.

    Article  PubMed  CAS  Google Scholar 

  13. Godard P, Chanez P, Siraudin L, Nicoloyannis N, Duru G. Costs of asthma are correlated with severity. Eur Respir J. 2002;19:61–67.

    Article  PubMed  CAS  Google Scholar 

  14. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Full Report 2007. National Heart, Lung, and Blood Institute, 2007. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed December 17, 2008.

  15. Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI). Global Strategy for Asthma Management and Prevention. Bethesda (MD): Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI); 2007. 92 p. [372 references] Available at: http://www.guideline.gov/summary/summary.aspx?doc_id=12274. Accessed December 17, 2008.

    Google Scholar 

  16. Ducharme FM. Inhaled glucocorticoids versus leukotriene receptor antagonists as single agent asthma treatment. BMJ. 2003;326:621–625.

    Article  PubMed  CAS  Google Scholar 

  17. Ducharme FM, diSalvio F. Anti-leukotriene agents compared with inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev. 2004;(1):CD002314. DOI: 10.1002/14651858.CD002314.pub2.

  18. Dijkstra A, Vonk JM, Jongepier H, et al. Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex. Thorax. 2006;61:105–110.

    Article  PubMed  CAS  Google Scholar 

  19. Lange P, Scharling H, Ulrik C S, Vestbo J. Inhaled corticosteroids and decline of lung function in community residents with asthma. Thorax. 2006;61:100–104.

    Article  PubMed  CAS  Google Scholar 

  20. Sullivan SD, Buxton M, Andersson F, et al. Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma. J Allergy Clin Immunol. 2003;12:1229–1236.

    Article  Google Scholar 

  21. O’Byrne P, Cuddy L, Taylor DW, Birch S, Morris J, Syrotuik J. Efficacy and cost benefit of inhaled corticosteroids in patients considered to have mild asthma in primary care practice. Can Respir J. 1996;3:169–175.

    Google Scholar 

  22. Colice GL, Yu AP, Ivanova JI, et al. Costs and resource use of mild persistent asthma patients initiated on controller therapy. J Asthma. 2008;45:293–299.

    Article  PubMed  Google Scholar 

  23. Hansen RA, Gartlehner G, Lohr KN, Carson S, Carey T. Drug Class Review on Inhaled Corticosteroids. Update #3: Preliminary Scan Report. Oregon Health & Science University. Last updated April 2007. Available at: http://www.rx.wa.gov/documents/ics_update_3.pdf. Accessed January 8, 2009.

  24. Thongngarm T, Silkoff PE, Kossack WS, Nelson HS. Hydrofluoroalkane-134A beclomethasone or chlorofluorocarbon fluticasone: effect on small airways in poorly controlled asthma. J Asthma. 2005;42:257–263.

    Article  PubMed  CAS  Google Scholar 

  25. Ohbayashi H, Adachi M. Hydrofluoroalkanebeclomethasone dipropionate effectively improves airway eosinophilic inflammation including the distal airways of patients with mild to moderate persistent asthma as compared with fluticasone propionate in a randomized open double-cross study. Allergol Int. 2008;57:231–239.

    Article  PubMed  CAS  Google Scholar 

  26. Ohbayashi H, Adachi M. Ichinose M, et al. [A multicenter, open-label, randomized comparison of suppressive effects on asthmatic inflammation of lower airways and improved effects on health-related QOL between HFA-BDP and fluticasone propionate]. Arerugi. 2007;56:577–586.

    PubMed  Google Scholar 

  27. National Committee for Quality Assurance. Use of Appropriate Medications for People with Asthma. HEDIS 2005, vol 2. Technical Specifications. Washington DC: NCQA; 2005.

    Google Scholar 

  28. Cooper J, Hall L, Penland A, Krueger A, May J. Measuring medication adherence. Popul Health Manag. 2009;12:25–30.

    Article  PubMed  Google Scholar 

  29. Ivanova JI, Birnbaum HG, Heish M, Yu AP, et al. Adherence to inhaled corticosteroid use and local adverse events in persistent asthma. Am J Manag Care. 2008;14:801–809.

    PubMed  Google Scholar 

  30. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  31. D’Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med. 1993;32:382–387.

    PubMed  Google Scholar 

  32. Leidy NK, Paramore LC, Watrous M, Doyle J, Zeiger RS. Development of an algorithm for estimating asthma severity from an administrative cost database. Value Health. 1999;2:394.

    Article  Google Scholar 

  33. McCullagh P, Nelder J. Generalized Linear Models. New York: Chapman and Hall; 1983:261.

    Google Scholar 

  34. Diehr P, Yanez D, Ash A, Hornbrook M, Lin DY. Methods for analyzing health care utilization and cost. Annu Rev Public Health. 1999;20:125–144.

    Article  PubMed  CAS  Google Scholar 

  35. Leach CL, Davidson PJ, Boudreau RJ. Improved airway targeting with the CFC-free HFA-beclomethasone metered-dose inhaler compared with CFCbeclomethasone. Eur Respir J. 1998;12:1346–1353.

    Article  PubMed  CAS  Google Scholar 

  36. Leach C. Effect of formulation parameters on hydrofluoroalkane-beclomethasone dipropionate drug deposition in humans. J Allergy Clin Immunol. 1999;104:S250–S252.

    Article  PubMed  CAS  Google Scholar 

  37. Corren J. Small airways disease in asthma. Curr Allergy Asthma Rep. 2008;8:533–539.

    Article  PubMed  CAS  Google Scholar 

  38. Yanai M, Sekizawa K, Ohrui T, et al. Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure. J Appl Physiol. 1992;72:1016–1023.

    PubMed  CAS  Google Scholar 

  39. Martin RJ. Therapeutic significance of distal airway inflammation in asthma. J Allergy Clin Immunol. 2002;109:S447–S460.

    Article  PubMed  Google Scholar 

  40. Stempel DA, McLaughlin T, Griffis DL, Stanford RH. Cost analysis of the use of inhaled corticosteroids in the treatment of asthma: a 1-year follow-up. Respir Med. 2001;95:992–998.

    Article  PubMed  CAS  Google Scholar 

  41. Gross G, Tompson PJ, Chervinsky P, Burgt JV. Hydrofluoroalkane-134a beclomethasone dipropionate, 400 μg, is as effective as chlorofuorocarbon beclomethasone dipropionate, 800 μg, for the treatment of modern asthma. Chest. 1999;115:343–351.

    Article  PubMed  CAS  Google Scholar 

  42. Busse WW, Brazinsky S, Jacobson K, et al. Efficacy response of inhaled beclomethasone dipropionate in asthma is proportional to dose and is improved by formulation with a new propellant. J Allergy Clin Immunol. 1999;104:1215–1222.

    Article  PubMed  CAS  Google Scholar 

  43. Lipworth BJ, Jackson CM. Pharmacokinetics of chlorofluorocarbon and hydrofluoroalkane metered-dose inhaler formulations of beclomethasone dipropionate. Br J Clin Pharmacol. 1999;48:866–868.

    Article  PubMed  CAS  Google Scholar 

  44. Leach CL, Davidson PJ, Hasselquist BE, Boudreau RJ. Lung deposition of hydrofluoroalkane-134a beclomethasone is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone: a cross-over study in healthy volunteers. Chest. 2002;122:510–516.

    Article  PubMed  CAS  Google Scholar 

  45. Malone DC, Luskin AT. Hydrofluoroalkane-134a beclomethasone as a dominant economic asthma therapy. Respir Med. 2003;97:1269–1276.

    Article  PubMed  CAS  Google Scholar 

  46. Lage MJ, Hassan MK. The relationship between antipsychotic medication adherence and patient outcomes among individuals diagnosed with bipolar disorder: a retrospective study. Ann Gen Psychiatry. 2009;8:7.

    Article  PubMed  Google Scholar 

  47. Lo Re V 3rd, Amorosa VK, Localio AR, et al. Adherence to hepatitis C virus therapy and early virologic outcomes. Clin Infect Dis. 2009;48:186–193.

    Article  PubMed  Google Scholar 

  48. Kulkarni AS, Balkrishnan R, Anderson RI, Edin HM, Krisch J, Stacy MA. Medication adherence and associated outcomes in medicare health maintenance organization-enrolled older adults with Parkinson’s disease. Mov Disord. 2008;23:359–365.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. HealthMetrics Outcomes Research, 120 Anchorage Circle, Groton, CT, 06340, USA

    Maureen J. Lage

  2. Dallas Allergy and Asthma Center, 5499 Glen Lakes Drive, Dallas, TX, 75231, USA

    Gary N. Gross

  3. Teva Respiratory, 425 Privet Road, Horsham, PA, 19044, USA

    Corrine Brewster & Anthony Spalitto

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  1. Maureen J. Lage
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  2. Gary N. Gross
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  4. Anthony Spalitto
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Correspondence to Maureen J. Lage.

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Lage, M.J., Gross, G.N., Brewster, C. et al. Outcomes and costs of patients with persistent asthma treated with beclomethasone dipropionate hydrofluoroalkane or fluticasone propionate. Adv Therapy 26, 762–775 (2009). https://doi.org/10.1007/s12325-009-0056-z

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