| Title | Appropriate use of inhaled corticosteroid and long-acting ss(2)-adrenergic agonist combination therapy among asthma patients in a US commercially insured population. | | Author(s) | Ye X, Gutierrez B, Zarotsky V, Nelson M, Blanchette CM | | Institution | i3 Innovus, Eden Prairie, MN, USA. | | Source | Curr Med Res Opin 2009 Jul 21. | | Abstract | ABSTRACT
Objective: To examine health care utilization measures indicating which asthma patients are appropriate for inhaled corticosteroid and long-acting ss(2)-adrenergic agonist (ICS/LABA) therapy and determine whether two ICS/LABA therapies were initiated in accordance with guidelines. Research design and methods: A retrospective cohort study of commercially insured asthma patients aged >/=12 years that initiated fluticasone propionate/salmeterol (FSC) or budesonide/formoterol fumarate dihydrate (BFC) combination therapy in 2007 was conducted. Use was considered appropriate if patients met any of the following during a 1-year period before ICS/LABA initiation: ICS or leukotriene receptor antagonist (LTRA) use; an asthma-related emergency department (ED) visit or hospitalization; >/=2 oral corticosteroids (OCS) courses; or >/=6 short-acting beta(2)-adrenergic agonist (SABA) canisters. Multivariate logistic regression was used to assess factors associated with appropriate ICS/LABA use. Certain limitations inherent to the use of claims data for research apply to this study.
Results: Of 24,231 patients who initiated ICS/LABA therapy, 993 received BFC and 23,238 received FSC. Among all patients, 37.6% met >/=1 criteria for appropriate use. However, compared with FSC users, BFC users had a significantly higher likelihood of meeting >/=1 of these criteria (odds ratio, 2.01; 95% CI, 1.76-2.30; p < 0.001), and a higher proportion of BFC than FSC patients met 4 of the 5 appropriate use criteria. In total, 58.4% of BFC patients versus 36.7% of FSC patients met >/=1 criteria for appropriate use. Other factors associated with appropriate use included age, region, Charlson comorbidity score, number of medications, and prescriber specialty.
Conclusion: Fewer than half of all patients fulfilled the specified criteria for being appropriate for ICS/LABA therapy. However, a significantly higher proportion of BFC than FSC users met the criteria for appropriate use of ICS/LABA therapy. These results may suggest a need for improved physician awareness of consensus guidelines for the initiation of ICS/LABA therapy. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19622006 |
|
