title: Relationship between short-acting β2-adrenergic agonist use and healthcare costs.
abstract: OBJECTIVE
  To assess whether increased short-acting β(2)-adrenergic agonist (SABA) claims are associated with asthma exacerbations and increased healthcare costs.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Patients (N = 93,604) were health plan members aged 6-56 years with at least 2 years of enrollment between July 1, 2003, and June 30, 2007, an asthma diagnosis, and at least 1 asthma medication claim per study year. Two years of administrative claims were collected. SABA use was categorized as 0 (none), (1/2) to 2 (low), 2(1/2) to 6 (moderate), 6(1/2) to 12 (high), and more than 12 (excessive) canister equivalents per year. Multivariate analyses were adjusted for age, sex, geographic region, comorbidities, specialist consultation, controller medication use, and asthma severity.
  
  
  RESULTS
  Half of high and excessive SABA users had few or no controller claims. Compared with SABA nonusers, high and excessive SABA users had significantly higher odds (odds ratio [95% confidence interval]) of asthma-related emergency department/urgent care visits (6.47 [5.25, 7.98] and 7.68 [6.04, 9.76], respectively), hospitalizations (5.37 [6.04, 9.76]; 6.90 [4.90, 9.73]), and oral corticosteroid use (2.89 [2.72, 3.08]; 3.71 [3.41, 4.03]). Excessive SABA users had 3.0 times ($1791) and high SABA users had 2.2 times ($1326) higher asthma-related healthcare costs than low SABA users ($595). Total costs also increased with higher SABA use, but with smaller incremental differences between excessive and high SABA users and low SABA users.
  
  
  CONCLUSIONS
  Increased SABA use is associated with higher total and asthma-related healthcare costs. Opportunity exists to lessen overreliance on SABAs.
authors.affiliation: Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis, NC 28081, USA.
authors.forename: Harris S
authors.initials: HS
authors.lastname: Silver
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Blanchette
authors.forename: Shital
authors.initials: S
authors.lastname: Kamble
authors.forename: Hans
authors.initials: H
authors.lastname: Petersen
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Letter
authors.forename: David
authors.initials: D
authors.lastname: Meddis
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gutierrez
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control; D002648:Child; D017046:Cost Savings; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006305:Health Status Indicators; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists