Impact of Asthma Controller Medications on Clinical, Economic, and Patient-Reported Outcomes

Abstract

OBJECTIVE:To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications. PATIENTS AND METHODS:This observational study, which used administrative claims data from US commercial health plans, included patients with asthma aged 18 through 64 years who filled a prescription for at least 1 asthma controller medication from September 1, 2003, through August 31, 2005. Outcome metrics included the use of short-acting b-agonists (SABAs), the use of oral corticosteroids, inpatient (INP)/emergency department (ED) visits, and asthma-related health care costs. A subset of 5000 patients was randomly selected for a survey using the Mini-Asthma Quality of Life Questionnaire, the Work Productivity and Activity Impairment questionnaire, and the Asthma Therapy Assessment Questionnaire.RESULTS: Of 56,168 eligible patients, 823 returned completed questionnaires. Compared with inhaled corticosteroids (ICSs), leukotriene modifiers (LMs) were associated with lower odds of INP/ED visits (odds ratio [OR], 0.80; P<.001), lower odds of using 6 or more SABA canisters (OR, 0.81; P<.001), and higher annual cost ($193; P<.001). In the subgroup analysis of adherent patients, LMs were associated with higher odds of INP/ED visits (OR, 1.74; P=.04), lower odds of using 6 or more SABA canisters (OR, 0.46; P<.001), and higher annual cost ($235; P<.001). Inhaled corticosteroids and LMs had a comparable impact on all patient-reported outcomes. For combination therapy, ICS plus a long-acting b-agonist consistently showed at least equivalent or better outcomes in the use of SABAs and oral corticosteroids, the risk of INP/ED visits, cost, asthma control level, quality of life, and impairment in productivity and activity.CONCLUSION: Inhaled corticosteroids were associated with a lower risk of INP/ED visits, and a lower cost if adherence was achieved. When adherence cannot be achieved, LMs may be a reasonable alternative. Combination therapy with ICS plus a longacting b-agonist was associated with better or equivalent clinical, economic, and patient-reported outcomes.

Toward the Optimal Control of Asthma

“…So what might be the optimal strategy for patients with mild or moderate persistent asthma? One choice, supported by the results of the study by Tan et al, 4 is to use leuko triene modifiers as first-line treatment. A second choice, as supported by clinical studies and recommended by the Expert Panel Report, is to use inhaled corticosteroids as the preferred initial treatment.…”

“…Both leukotriene modifiers and inhaled corticosteroids are efficacious in the treatment of asthma, and clinical studies show that inhaled corticosteroids are more efficacious than leukotriene modifiers. However, the study by Tan et al 4 suggests that the use of leukotriene modifiers is more effective than inhaled corticosteroids in real-world conditions. So what might be the optimal strategy for patients with mild or moderate persistent asthma?…”

“…This importance of adherence to asthma medication use is highlighted by the results of the "real-world" asthma study by Tan et al 4 …”

“…Further analysis of the study by Tan et al 4 shows that only 3.4% of patients prescribed inhaled corticosteroids met criteria for good adherence (ie, took 80% of prescribed doses). This is a dismal and discouraging finding, espe-T he optimal management of asthma is not simple.…”

The High Cost of Cancer Drugs and What We Can Do About It

“…One can argue that a monopoly as described previously herein would be temporary at best because eventually similar drugs of the same class would emerge, offering competition that should in theory act as a price check. However, owing to some of the factors described previously herein, the price check offered by generics in nonmalignant diseases [21][22][23] is effectively neutered in the case of cancer. For example, in nonmalignant diseases, a new and improved treatment that simply offers incremental benefits over established treatment but costs considerably more than the generic version will not be able to maintain a high price if the incremental benefits do not provide value to the patient.…”