title: Outcomes and costs of patients with persistent asthma treated with beclomethasone dipropionate hydrofluoroalkane or fluticasone propionate.
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.
authors: HealthMetrics Outcomes Research, 120 Anchorage Circle, Groton, CT 06340, USA. lagemj@hlthmetrics.com
authors: Maureen J
authors: MJ
authors: Lage
authors: Gary N
authors: GN
authors: Gross
authors: Corrine
authors: C
authors: Brewster
authors: Anthony
authors: A
authors: Spalitto
mesh_terms: D000328:Adult; D000730:Androstadienes / Q000191:economics*; D018927:Anti-Asthmatic Agents / Q000191:economics*; D000893:Anti-Inflammatory Agents / Q000191:economics*; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D001507:Beclomethasone / Q000191:economics*; D017281:Cost of Illness; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D000068298:Fluticasone; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007344:Insurance Claim Reporting / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D018579:Patient Selection; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone; D001507:Beclomethasone