Outcomes and costs of patients with persistent asthma treated with beclomethasone dipropionate hydrofluoroalkane or fluticasone propionate.
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.
Lage
Maureen J
MJ
HealthMetrics Outcomes Research, 120 Anchorage Circle, Groton, CT 06340, USA. lagemj@hlthmetrics.com
Gross
Gary N
GN
Brewster
Corrine
C
Spalitto
Anthony
A
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
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone; D001507:Beclomethasone