DRUG UTILIZATION EVALUATION IDENTIFIES COSTS ASSOCIATED WITH HIGH USEOF BETA-ADRENERGIC AGONISTS

Background: Drug utilization evaluation is an effective mechanism to i dentify individual variability in drug use and to promote intervention s that will improve patient outcomes. The present analysis is a novel approach incorporating medical claims information with pharmacy data. Method: This analysis was conducted during the 12 months of 1993 in fo ur health maintenance organizations with approximately 673,000 members . Health care costs were identified in asthmatic patients, age 7 years and over, who used high doses of inhaled beta-adrenergic agonists, de fined as more than 8 puffs per day. Results: A total of 20,512 asthmat ic patients were identified. From these patients, 1093 members or 5.3% received high doses of an inhaled bronchodilator. This second group w as then stratified by concurrent use of inhaled anti-inflammatory ther apy. Group A, 32% of the members, received greater than or equal to 4 puffs per day of an antiinflammatory medicine; group B, 31% of the mem bers, received <4 puffs per day of these medicines; and group C, 37% o f the members, received no antiinflammatory therapy. Examination of th e linked medical claims and pharmacy database demonstrated that member s using high doses of inhaled bronchodilators had annual charges for t reatment related to their asthma that were 3.0 times higher than the a verage asthmatic patient ($1,346.52 versus $447.42). The high beta-ago nist users had inpatient hospital and emergency department charges tha t grew proportionally as a percent of total annual expenses. Medicatio n charges were 10% greater as a measure of total annual costs while fe es for ambulatory services were down 11% for high users of beta-agonis ts compared with the average asthmatic patient. Inpatient hospital cos ts in group B were 12% higher than group A. Conclusion: Patients not f ollowing the National and International guidelines appear to be more l ikely to consume greater amounts of health care resources. This drug u tilization evaluation demonstrates that there is a failure by the prov ider or patient with implementation and maintenance of these recommend ations. Noncompliance with guidelines was associated with increased mo rbidity and cost for asthma related care. Interventions targeting thes e members may improve clinical outcomes and decrease total cost for th e treatment of asthma.