Reduction in health care resource utilization associated with extended-release theophylline.
BACKGROUND
People with airway disease are high utilizers of health care resources. Few studies document the value of alternative therapies in reducing utilization. Studies examining theophylline, which demonstrate reduction in resource utilization, have been primarily of short duration in hospitalized settings with small samples.


OBJECTIVE
The purpose of this study was to examine the role of oral extended-release theophylline in reducing health care utilization over an extended period of time when added to existing inhaler therapy for ambulatory patients with airway disease.


METHODS
We used a retrospective, pretest/posttest design in examining the 1990-1993 South Carolina Medicaid database to compare health care utilization of 455 ambulatory patients for 4 months before and 6 months after extended-release theophylline was added to their treatment regimen. We assessed the following three outcomes: inhaler use, physician office visits, and emergency department visits, all measured in units/person/month.


RESULTS
Our sample consisted of patients taking beta2-agonist only (n = 393), steroid only (n = 25), and beta2-agonist plus steroid (n = 37). Inhaler use and physician office visits declined significantly among beta2-agonist users, as well as within the entire sample. Initiation of extended-release theophylline therapy was associated with a 30% decline in utilization of inhaler and physician office visits, influenced mostly by the decline with the beta2-agonist group.


CONCLUSIONS
The results of this effectiveness study using an administrative claims database are consistent with the published randomized clinical trials that document the value of extended-release theophylline when added to existing inhaler therapy.
Schulz
R M
RM
College of Pharmacy, University of South Carolina, Columbia 29208, USA.
Yates
W N
WN
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005006:Ethnicity; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016037:Single-Blind Method; D013022:South Carolina / Q000453:epidemiology; D013806:Theophylline / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D014481:United States
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D013806:Theophylline