title: Inappropriate overuse of inhaled corticosteroids for COPD patients: impact on health costs and health status.
abstract: The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: <euro>1,590 (SD = 1,834) vs. <euro>1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36-5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02-1.97)], depression [OR: 1.47 (95% CI: 1.05-2.05)], any allergy [OR 1.69 (95% CI: 1.13-2.54)], and physical health status [OR 0.97 (95% CI: 0.96-0.98)]. Lack of adherence to the recommended criteria for using inhaled corticosteroids therapy in the management of COPD patients was associated with lower self-reported health status and higher costs. Factors statistically associated with inappropriate use of corticosteroids were educational attainment, a history of heart disease, depression, any allergy, and physical health status.
authors.affiliation: Pneumology Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain. jmiguel.hgugm@salud.madrid.org
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel-Díez
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco-Garrido
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas-Gutierrez
authors.forename: Antonio
authors.initials: A
authors.lastname: Martín-Centeno
authors.forename: Elena
authors.initials: E
authors.lastname: Gobartt-Vázquez
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernandez-Barrera
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gil de
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jimenez-Garcia
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000191:economics; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones