Appropriate use of inhaled corticosteroid and long-acting beta(2)-adrenergic agonist combination therapy among asthma patients in a US commercially insured population.

Abstract

OBJECTIVE:

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.

RESEARCH DESIGN AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: Xin Ye, Benjamin Gutierrez, Victoria Zarotsky, Michael Nelson, Christopher M Blanchette
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 25 Issue 9 Pg. 2251-8 (Sep 2009) ISSN: 1473-4877 [Electronic] England
• PMID: 19622006 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Adrenergic Agonists
• Adrenergic beta-2 Receptor Agonists
• Anti-Asthmatic Agents

Topics

• Administration, Inhalation
• Adolescent
• Adrenal Cortex Hormones (administration & dosage, economics)
• Adrenergic Agonists (administration & dosage, economics)
• Adrenergic beta-2 Receptor Agonists
• Adult
• Aged
• Anti-Asthmatic Agents (administration & dosage, economics)
• Asthma (drug therapy, economics)
• Child
• Commerce
• Drug Therapy, Combination
• Drug Utilization (economics, statistics & numerical data)
• Female
• Humans
• Insurance Coverage (statistics & numerical data)
• Male
• Middle Aged
• Population
• Retrospective Studies
• United States
• Young Adult