Author(s)
Bhash Parasuraman, PhD, Value Demonstration Leader1, Aidan Long, MD, Clinical Director of Allergy2, Eugene Bleecker, MD, Professor of Medicine3, Richard O'Connor, MD, Director, Dept. of Quality Management4, Donald Tashkin, MD, Professor of Medicine5, Stephen Peters, MD, PhD, Professor of Medicine3, Philip Silkoff, MD, Director, Clinical Research1, Robert Boggs, PhD, Formerly AstraZeneca61AstraZeneca, Wilmington, DE, USA; 2 Massachusetts General Hospital, Boston, MA, USA; 3 Wake Forest University, Winston-Salem, NC, USA; 4 Sharp Rees-Stealy Medical Group, San Diego, CA, USA; 5 UCLA, Los Angeles, CA, USA; 6 Formerly AstraZeneca, Wilmington, DE, USA
OBJECTIVES: To assess in a managed care setting the sub-acute lack of asthma control (SALAC) identified by excess short-acting ß2-agonist (SABA) use or clinic visits but not necessarily associated with acute asthma exacerbations. METHODS: An administrative claims database containing 8.8 million lives was analyzed over 4 years (June 2000 - May 2004). Patients aged =12 years with an ICD-9 code for asthma and =2 claims/year for asthma medication were included; those with other significant respiratory conditions were not. SALAC was defined as >4 clinic visits for asthma/year or =2/quarter, or >5 SABA prescriptions/year. Acute asthma exacerbations were defined as asthma-related emergency department visits, hospitalizations, or oral corticosteroid bursts. SALAC rates during years 2-4 were compared for patients who had loss of control during year 1 with patients who did not. RESULTS: Of 3998 patients (mean age=41 years, 65% female) who met the study criteria, only 42% had an acute exacerbation but 70% had SALAC in the 4-year period (63% excess clinic visits/year, 36% excess SABA/year); 22% had SALAC in only 1 of the 4 years, 16% in 2 of the 4 years, 14% in 3 of the 4 years, and 18% in all 4 years. Patients experiencing SALAC in year 1 were more likely to do so again in years 2-4 vs. all other patients (83% v. 47%; p<.001). SALAC rates/year changed little over the 4-year period (year 1: 44%; year 2: 45%; year 3: 42%; year 4: 37%). CONCLUSION: A sub-acute loss of asthma control (SALAC) in 1 year predicts SALAC in a subsequent year. SALAC occurred in more than two thirds of patients at some point and occurred every year in almost one fifth. Asthma control is also lacking in many patients who did not have an acute exacerbation.
Conference/Value in Health Info
2007-05, ISPOR 2007, Arlington, VA, USA
Value in Health, Vol. 10, No.3 (May/June 2007)
Code
PAA11
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Treatment Patterns and Guidelines
Disease
Respiratory-Related Disorders
