title: Potential savings from increasing adherence to inhaled corticosteroid therapy in Medicaid-enrolled children.
abstract: BACKGROUND
  Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx).
  
  
  OBJECTIVE
  We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children.
  
  
  METHODS
  We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007.
  
  
  METHODS
  Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%.
  
  
  RESULTS
  Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence.
  
  
  CONCLUSIONS
  If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma.
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310. E-mail: GRust@msm.edu.
authors.forename: George
authors.initials: G
authors.lastname: Rust
authors.forename: Shun
authors.initials: S
authors.lastname: Zhang
authors.forename: Luceta
authors.initials: L
authors.lastname: McRoy
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
mesh_terms: D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid; D055118:Medication Adherence; D014481:United States
chemical_list: D005938:Glucocorticoids