Exploring asthma control cutoffs and economic outcomes using the Asthma Control Questionnaire.
Understanding the effect of worsening asthma control on expenditures and health resource utilization (HRU) is important.



To explore the association of economic outcomes with asthma control cutoffs and longitudinal changes on the Asthma Control Questionnaire 5 (ACQ-5).



The Observational Study of Asthma Control and Outcomes was a survey of patients with persistent asthma who were patients of Kaiser Colorado, including claims-based HRU. Patients completed the ACQ-5 three times during 1 year between April 2011 and June 2012. The ACQ-5 cutoffs that indicated control were assessed in cross-sectional analyses. Longitudinal changes in control were explored: controlled (ACQ-5 score <0.75), indeterminate (ACQ-5 score 0.75 to <1.5), not well controlled (ACQ-5 score 1.5 to <3.0), and very poorly controlled (ACQ-5 score ≥3.0). Analyses used generalized linear models with log link (expenditures) and negative binomial regression (HRU).



There were 6,666 completed surveys (1,799 individuals completed all 3 survey waves). In the cross-sectional analyses, compared with an ACQ-5 score less than 0.5, individuals with ACQ-5 scores of 4 to 4.5 incurred 7.2 times the number of oral corticosteroid prescriptions, 4.3 times the number of emergency department visits, 6 times the number of inpatient visits, 10.4 times the number of asthma-specific emergency department visits, 4.58 times the number of asthma-specific inpatient visits, and $2,892 more in all-cause and $1,877 in asthma-specific expenditures during 4 months. In the longitudinal change analyses, individuals who improved from an ACQ-5 of 3.0 or greater to less than 0.75 incurred $6,023 less in asthma-specific expenditures during 4 months than those remaining at an ACQ-5 score of 3.0 or higher.



Results provide preliminary economic data on possible control cutoffs for the ACQ-5. Improving asthma control over time may result in significant savings that may justify financial investments designed to improve control.
Regis University School of Pharmacy, Denver, Colorado. Electronic address: psulliva@regis.edu.
Patrick W
PW
Sullivan
Amgen Inc, Thousand Oaks, California.
Gary
G
Globe
Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado; American University of Armenia, Yerevan, Armenia.
Vahram H
VH
Ghushchyan
Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado.
Jonathan D
JD
Campbell
Department of Pediatrics, National Jewish Health, Denver, Colorado.
Bruce
B
Bender
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
David J
DJ
Magid
D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D011241:Prednisone