Background: Drug utilization evaluation is an effective mechanism to identify individual variability in drug use and to promote interventions that will improve patient outcomes. The present analysis is a novel approach incorporating medical claims information with pharmacy data.
Method: This analysis was conducted during the 12 months of 1993 in four health maintenance organizations with approximately 673,000 members. Health care costs were identified in asthmatic patients, age 7 years and over, who used high doses of inhaled beta-adrenergic agonists, defined as more than 8 puffs per day.
Results: A total of 20,512 asthmatic patients were identified. From these patients, 1093 members or 5.3% received high doses of an inhaled bronchodilator. This second group was then stratified by concurrent use of inhaled anti-inflammatory therapy. Group A, 32% of the members, received > or = 4 puffs per day of an anti-inflammatory medicine; group B, 31% of the members, received <4 puffs per day of these medicines; and group C, 37% of the members, received no anti-inflammatory therapy. Examination of the linked medical claims and pharmacy database demonstrated that members using high doses of inhaled bronchodilators had annual charges for treatment related to their asthma that were 3.0 times higher than the average asthmatic patient ($1,346.52 versus $447.42). The high beta-agonist users had inpatient hospital and emergency department charges that grew proportionally as a percent of total annual expenses. Medication charges were 10% greater as a measure of total annual costs while fees for ambulatory services were down 11% for high users of beta-agonists compared with the average asthmatic patient. In patient hospital costs in group B were 12% higher than group A.
Conclusion: Patients not following the National and International guidelines appear to be more likely to consume greater amounts of health care resources. This drug utilization evaluation demonstrates that there is a failure by the provider or patient with implementation and maintenance of these recommendations. Noncompliance with guidelines was associated with increased morbidity and cost for asthma related care. Interventions targeting these members may improve clinical outcomes and decrease total cost for the treatment of asthma.