ASTHMA-TREATMENT COSTS USING INHALED CORTICOSTEROIDS

Asthma is a chronic inflammatory disorder of the airways that affects 10 to 17.5 million people and leads to more than $5 billion in treatme nt costs in the United States annually This retrospective study is an initial step in understanding the beneficial economic outcomes of inha led corticosteroid therapy by determining whether differences exist in healthcare utilization expenditures for three inhaled corticosteroids available for use in the United States: (1) beclomethasone dipropiona te (Vanceril(R)/Schering and Beclovent(R)/Allan & Hanburys); (2) fluni solide (Aerobid(R)/Forest); and (3) and triamcinolone acetonide (Azmac ort(R)/Rhone-Poulenc Rorer). The study was based on an analysis of 4,4 41 patients with at least one pharmaceutical claim for one of the stud y drugs, using inpatient, outpatient, and prescription drug claims dat a obtained from The MEDSTAT Group's MarketScan(R) database for calenda r years 1990 through 1993. We tested a null hypothesis for no differen ces in total asthma treatment costs, when drugs were excluded, using m ultivariate linear regression modeling controlling for patient demogra phic and clinical characteristics that might affect the study outcome. We found that, after excluding study drug payments and controlling fo r other contributing factors, total asthma healthcare expenditures for triamcinolone acetonide (Azmacort) users were higher than those for b eclomethasone dipropionate (Vanceril and Beclovent) and flunisolide (A erobid) users. When study drug costs were included in the expenditure measure, both triamcinolone acetonide (Azmacort) and flunisolide (Aero bid) users had higher expenditures than did beclomethasone dipropionat e (Vanceril and Beclovent) users. No significant differences in expend itures were detected between Vanceril and Beclovent patients, a findin g consistent with the fact that these drugs are the same type of inhal ed corticosteroid. Other factors contributing to differences in total asthma healthcare costs included patient age, patterns of switching am ong and continuing with study drugs, prestudy asthma utilization or dr ug proxy severity, and comorbidities or Precipitating illnesses.