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Direct costs of allergen immunotherapy for allergic rhinitis in the united states: Estimates from the 1996 Medical Expenditure Panel Survey
$208
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Abstracts
Direct Costs of Allergen Immunotherapyfor Allergic Rhinitis in the United States: Estimatesfrom the 1996 Medical Expenditure Panel Survey
J. S. Sundy I, A. W. Law 2, S. D. Reed 2, K. A. Schulman2; IDivision of Allergy and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 2Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, RATIONALE: To estimate the direct costs of specific imnmnotherapy (IT) for the treatment of allergic rhinitis (AR) in the United States. METHODS: We examined healthcare costs and resource utilization related to IT for AR using the 1996 Medical Expenditure Panel Survey. RESULTS: The total direct medical cost of AR was estimated at $3.4 billion in 1996. Over 50% of outpatient visits for AR (19.5 million) were associated with administering IT to an estimated 1.8 million people. The total cost attributable to IT was approximately $691 million. The 13% of AR patients receiving IT accounted for 36% of the total direct cost related to AR. Direct costs were 3.6-fold higher for IT patients ($661/yr IT vs. $182/yr non-IT). Outpatient costs for IT patients were $524/yr compared to $67/yr for patients not on IT. Most of this extra cost ($375) was directly related to office visits for IT. Average annual medication costs were 23% higher in patients receiving IT ($135 vs. $111 ). Patients with private health insurance were over-represented among IT patients (81% of IT patients vs. 65% of non-IT patients). Medicaid beneficiaries were least likely to receive IT (0.9% of IT patients vs. 7% of non-IT patients). CONCLUSIONS: The cost of treating AR was 3.6-fold higher in patients receiving IT. Patients without private insurance were under-represented among AR patients receiving IT. Additional studies are needed to clarify the costs and benefits of IT, and to investigate the impact of type of insurance on access to IT for AR patients.
Funding: Self-funded
559 inCostsa Hospital-based and Health Care Utilization (HCU) in Adults with Asthma HM0: Influence of Poorly Controlled Patients E. R. Soriano j, R. G6mez ~, A. Scharfner I, D. Hares l, A. Beratarrechea t, E, Lifschitz I, S. Figar I , G. Machnicki 2, A. Castronuovo2, A. De La Canat 3, M. Marchetti I, E Gonzalez Bernaldo de Quirosl; IServicio de Clfnica M6dica y Gerencia M6dica Plan de Salud, Hospital Italiano de Buenos Aires, Capital Federal, ARGENTINA, 2Novartis Argentina, Capital Federa'l, ARGENTINA, 3Secci6n Neumonologia, Servicio de Clfnica M6dica, Hospital Italiano de Buenos Aires, Capital Federal, ARGENTINA. RATIONALE: To compare HCU and direct medical costs of adult patients with asthma with the general population, and to analyze the impact of poorly controlled patients. PATIENTS AND METHODS: All members diagnosed with asthma in the HMO computer-based patient record system, or on admission to hospital, or who had purchased on at least 4 occasions antiasthmatic medication were included. All direct medical expenditures and HCU during year 2000 were considered, and compared with mean values of the adult HMO population, standardized by asthmatic's sex and age distribution. Poorly controlled patients were those who had experienced at least one hospitalization or emergency room visit due to asthma. Continuous variables were compared with Mann-Whitney test. RESULTS: 1359 patients were identified (815 females; mean age: 56 years (16-96)). Eight percent (109) patients were poorly controlled. Asthmatic patients had significantly more mean annual hospital admissions (0,30 vs. 0,1; p<0,001); mean annual medications purchased (29 vs. 10: p<0,001) and mean annual medical visits (11,5 vs. 6,4; p<0,001) than controls. Patients also had significantly more medical costs (mean $: 2267 vs. 796; p<0,001 ). Poorly controlled patients had significantly more HCU and mean medical costs ($: 6845 vs. 1867; p<0,001) than controlled patients. CONCLUSIONS: Asthmatic patients used significantly more health care resources and were more costly than the age and sex standardized HMO
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
population. The 8% of poorly controlled patients consumed 24% of asthmatic total medical costs. Better control of asthma might reduce HCU and medical costs.
Funding: Novartis
60 After Use of Long-Term Asthma Controller Medications Before and a Hospitalizationor Emergency Department Visit A. Atherly I, S. G. Williams2; IHealth Policy and Management, Emory University, Atlanta, GA, 2National Center for Environmental Health, Centers for Disease Control, Atlanta, GA. RATIONALE: This abstract examines the use of long-term asthma controller medications (LTACM) before and after asthma-related inpatient stays and emergency department events (EDE). METHODS: Data were from the 1997 Medstat-Marketscan claims database. Asthma-related events were defined as EDE or inpatient hospital stay with a primary or secondary diagnosis of asthma. LTACM included corticosteroids, xanthines, leukotriene modifiers and combination medications. RESULTS: The sample totaled of 464 individuals with an asthma-related EDE and 747 with a hospital stay. Of the EDE sample, 60% filled a prescription for LTACM during the calendar year. 32% had filled a prescription prior to the EDE with an average of 85 days between the prescription being filled and the EDE. 20% filled a prescription during the month subsequent to the EDE and 35% during the subsequent calendar year. Of those with a hospital stay, 60% filled a prescription for LTACM during the calendar year. Of those that filled a prescription prior to the hospitalization, there was an average of 70.4 days between the filling of the prescription and the event. 44% of the hospital sample filled a prescription afterward, with 65% doing so within 30 days. CONCLUSIONS: We find that many of those seeking care have been prescribed controller medications, but have not complied with the drug regimen. Even after an adverse event, a slight majority continues to not fill prescriptions. One approach for improving the health of those with asthma and reducing asthma expenditures will be to monitor and improve compliance with prescribed medication protocols.
Funding: Centersfor Disease Control
561 menslnapparent R Bornaclhi eNon-adherence g Asthma i -to Inhaled f o Corticosteroids r M. S. Kaplan; Permanente Med., Oakland, CA. RATIONALE: Physicians and patients may not be aware of non-adherence to prescribed inhaled corticosteroid regimens from prolonged use of dispensers void of medication. METHODS: Forty chronic asthmatics using inhaled corticosteroids (fluticasone or smaller-sized particle beclomethasone) were evaluated during office visits for medical regimen adherence by interview and review of pharmacy records. Clinical status was evaluated by history, physical examination, spirometry, beta-agonist, oral and increased inhaled corticosteroid usage. RESULTS: Of the 40 patients interviewed, 35 did not know the exact number of inhalations in each dispenser and 28 relied on shaking, taste or other methods for replacement. Five patients tracked inhalations to match the number present in dispenser; 10 patients said they started a new inhaler monthly; 6 patients used different inhalers with the same medication concurrently. Pharmacy records showed 32 patients using fewer dispensers than expected. Twenty-five patients were clinically stable; 15 were clinically unstable and 13 of these were not replacing inhalers as prescribed. CONCLUSIONS: Non-adherence to prescribed regimens can occur from patients using same dispensers for prolonged periods. Pharmacy records often show different usage from patient reports. This may lead to unstable asthma, but also indicates many patients remain clinically stable using less medication than prescribed. Unitormity in number of inhalations per dispenser for different medications, easy ways to track inhalations in dispensers, repeated patient education and pharmacy record review, would assist in optimizing doses of inhaled corticosteroids for bronchial asthma.
Funding: Self:funded
58
Abstracts
Direct Costs of Allergen Immunotherapyfor Allergic Rhinitis in the United States: Estimatesfrom the 1996 Medical Expenditure Panel Survey
J. S. Sundy I, A. W. Law 2, S. D. Reed 2, K. A. Schulman2; IDivision of Allergy and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 2Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, RATIONALE: To estimate the direct costs of specific imnmnotherapy (IT) for the treatment of allergic rhinitis (AR) in the United States. METHODS: We examined healthcare costs and resource utilization related to IT for AR using the 1996 Medical Expenditure Panel Survey. RESULTS: The total direct medical cost of AR was estimated at $3.4 billion in 1996. Over 50% of outpatient visits for AR (19.5 million) were associated with administering IT to an estimated 1.8 million people. The total cost attributable to IT was approximately $691 million. The 13% of AR patients receiving IT accounted for 36% of the total direct cost related to AR. Direct costs were 3.6-fold higher for IT patients ($661/yr IT vs. $182/yr non-IT). Outpatient costs for IT patients were $524/yr compared to $67/yr for patients not on IT. Most of this extra cost ($375) was directly related to office visits for IT. Average annual medication costs were 23% higher in patients receiving IT ($135 vs. $111 ). Patients with private health insurance were over-represented among IT patients (81% of IT patients vs. 65% of non-IT patients). Medicaid beneficiaries were least likely to receive IT (0.9% of IT patients vs. 7% of non-IT patients). CONCLUSIONS: The cost of treating AR was 3.6-fold higher in patients receiving IT. Patients without private insurance were under-represented among AR patients receiving IT. Additional studies are needed to clarify the costs and benefits of IT, and to investigate the impact of type of insurance on access to IT for AR patients.
Funding: Self-funded
559 inCostsa Hospital-based and Health Care Utilization (HCU) in Adults with Asthma HM0: Influence of Poorly Controlled Patients E. R. Soriano j, R. G6mez ~, A. Scharfner I, D. Hares l, A. Beratarrechea t, E, Lifschitz I, S. Figar I , G. Machnicki 2, A. Castronuovo2, A. De La Canat 3, M. Marchetti I, E Gonzalez Bernaldo de Quirosl; IServicio de Clfnica M6dica y Gerencia M6dica Plan de Salud, Hospital Italiano de Buenos Aires, Capital Federal, ARGENTINA, 2Novartis Argentina, Capital Federa'l, ARGENTINA, 3Secci6n Neumonologia, Servicio de Clfnica M6dica, Hospital Italiano de Buenos Aires, Capital Federal, ARGENTINA. RATIONALE: To compare HCU and direct medical costs of adult patients with asthma with the general population, and to analyze the impact of poorly controlled patients. PATIENTS AND METHODS: All members diagnosed with asthma in the HMO computer-based patient record system, or on admission to hospital, or who had purchased on at least 4 occasions antiasthmatic medication were included. All direct medical expenditures and HCU during year 2000 were considered, and compared with mean values of the adult HMO population, standardized by asthmatic's sex and age distribution. Poorly controlled patients were those who had experienced at least one hospitalization or emergency room visit due to asthma. Continuous variables were compared with Mann-Whitney test. RESULTS: 1359 patients were identified (815 females; mean age: 56 years (16-96)). Eight percent (109) patients were poorly controlled. Asthmatic patients had significantly more mean annual hospital admissions (0,30 vs. 0,1; p<0,001); mean annual medications purchased (29 vs. 10: p<0,001) and mean annual medical visits (11,5 vs. 6,4; p<0,001) than controls. Patients also had significantly more medical costs (mean $: 2267 vs. 796; p<0,001 ). Poorly controlled patients had significantly more HCU and mean medical costs ($: 6845 vs. 1867; p<0,001) than controlled patients. CONCLUSIONS: Asthmatic patients used significantly more health care resources and were more costly than the age and sex standardized HMO
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
population. The 8% of poorly controlled patients consumed 24% of asthmatic total medical costs. Better control of asthma might reduce HCU and medical costs.
Funding: Novartis
60 After Use of Long-Term Asthma Controller Medications Before and a Hospitalizationor Emergency Department Visit A. Atherly I, S. G. Williams2; IHealth Policy and Management, Emory University, Atlanta, GA, 2National Center for Environmental Health, Centers for Disease Control, Atlanta, GA. RATIONALE: This abstract examines the use of long-term asthma controller medications (LTACM) before and after asthma-related inpatient stays and emergency department events (EDE). METHODS: Data were from the 1997 Medstat-Marketscan claims database. Asthma-related events were defined as EDE or inpatient hospital stay with a primary or secondary diagnosis of asthma. LTACM included corticosteroids, xanthines, leukotriene modifiers and combination medications. RESULTS: The sample totaled of 464 individuals with an asthma-related EDE and 747 with a hospital stay. Of the EDE sample, 60% filled a prescription for LTACM during the calendar year. 32% had filled a prescription prior to the EDE with an average of 85 days between the prescription being filled and the EDE. 20% filled a prescription during the month subsequent to the EDE and 35% during the subsequent calendar year. Of those with a hospital stay, 60% filled a prescription for LTACM during the calendar year. Of those that filled a prescription prior to the hospitalization, there was an average of 70.4 days between the filling of the prescription and the event. 44% of the hospital sample filled a prescription afterward, with 65% doing so within 30 days. CONCLUSIONS: We find that many of those seeking care have been prescribed controller medications, but have not complied with the drug regimen. Even after an adverse event, a slight majority continues to not fill prescriptions. One approach for improving the health of those with asthma and reducing asthma expenditures will be to monitor and improve compliance with prescribed medication protocols.
Funding: Centersfor Disease Control
561 menslnapparent R Bornaclhi eNon-adherence g Asthma i -to Inhaled f o Corticosteroids r M. S. Kaplan; Permanente Med., Oakland, CA. RATIONALE: Physicians and patients may not be aware of non-adherence to prescribed inhaled corticosteroid regimens from prolonged use of dispensers void of medication. METHODS: Forty chronic asthmatics using inhaled corticosteroids (fluticasone or smaller-sized particle beclomethasone) were evaluated during office visits for medical regimen adherence by interview and review of pharmacy records. Clinical status was evaluated by history, physical examination, spirometry, beta-agonist, oral and increased inhaled corticosteroid usage. RESULTS: Of the 40 patients interviewed, 35 did not know the exact number of inhalations in each dispenser and 28 relied on shaking, taste or other methods for replacement. Five patients tracked inhalations to match the number present in dispenser; 10 patients said they started a new inhaler monthly; 6 patients used different inhalers with the same medication concurrently. Pharmacy records showed 32 patients using fewer dispensers than expected. Twenty-five patients were clinically stable; 15 were clinically unstable and 13 of these were not replacing inhalers as prescribed. CONCLUSIONS: Non-adherence to prescribed regimens can occur from patients using same dispensers for prolonged periods. Pharmacy records often show different usage from patient reports. This may lead to unstable asthma, but also indicates many patients remain clinically stable using less medication than prescribed. Unitormity in number of inhalations per dispenser for different medications, easy ways to track inhalations in dispensers, repeated patient education and pharmacy record review, would assist in optimizing doses of inhaled corticosteroids for bronchial asthma.
Funding: Self:funded