title: Impact of asthma controller medications on clinical, economic, and patient-reported outcomes.
abstract: To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Health Outcomes Research, HealthCore, Wilmington, DE 19801, USA. jtan@healthcore.com
authors: Hiangkiat
authors: H
authors: Tan
authors: Chaitanya
authors: C
authors: Sarawate
authors: Joseph
authors: J
authors: Singer
authors: Kurt
authors: K
authors: Elward
authors: Rubin I
authors: RI
authors: Cohen
authors: Brian A
authors: BA
authors: Smart
authors: Michael F
authors: MF
authors: Busk
authors: James
authors: J
authors: Lustig
authors: Jeana D
authors: JD
authors: O'Brien
authors: Michael
authors: M
authors: Schatz
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000191:economics*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015289:Leukotrienes / Q000008:administration & dosage* / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D010358:Patient Participation; D011336:Probability; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015289:Leukotrienes