Impact of asthma controller medications on clinical, economic, and patient-reported outcomes

Mayo Clin Proc. 2009 Aug;84(8):675-84. doi: 10.1016/S0025-6196(11)60517-X.

Abstract

Objective: To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications.

Patients and methods: This observational study, which used administrative claims data from US commercial health plans, included patients with asthma aged 18 through 64 years who filled a prescription for at least 1 asthma controller medication from September 1, 2003, through August 31, 2005. Outcome metrics included the use of short-acting beta-agonists (SABAs), the use of oral corticosteroids, inpatient (INP)/emergency department (ED) visits, and asthma-related health care costs. A subset of 5000 patients was randomly selected for a survey using the Mini-Asthma Quality of Life Questionnaire, the Work Productivity and Activity Impairment questionnaire, and the Asthma Therapy Assessment Questionnaire.

Results: Of 56,168 eligible patients, 823 returned completed questionnaires. Compared with inhaled corticosteroids (ICSs), leukotriene modifiers (LMs) were associated with lower odds of INP/ED visits (odds ratio [OR], 0.80; P<.001), lower odds of using 6 or more SABA canisters (OR, 0.81; P<.001), and higher annual cost ($193; P<.001). In the subgroup analysis of adherent patients, LMs were associated with higher odds of INP/ED visits (OR, 1.74; P=.04), lower odds of using 6 or more SABA canisters (OR, 0.46; P<.001), and higher annual cost ($235; P<.001). Inhaled corticosteroids and LMs had a comparable impact on all patient-reported outcomes. For combination therapy, ICS plus a long-acting beta-agonist consistently showed at least equivalent or better outcomes in the use of SABAs and oral corticosteroids, the risk of INP/ED visits, cost, asthma control level, quality of life, and impairment in productivity and activity.

Conclusion: Inhaled corticosteroids were associated with a lower risk of INP/ED visits, and a lower cost if adherence was achieved. When adherence cannot be achieved, LMs may be a reasonable alternative. Combination therapy with ICS plus a long-acting beta-agonist was associated with better or equivalent clinical, economic, and patient-reported outcomes.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Administration, Oral
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / economics
  • Adult
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / economics*
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Asthma / economics
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Drug Utilization
  • Female
  • Follow-Up Studies
  • Humans
  • Leukotrienes / administration & dosage*
  • Leukotrienes / economics
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Office Visits / statistics & numerical data
  • Patient Participation
  • Probability
  • Retrospective Studies
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Leukotrienes