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Patterns of Intranasal Corticosteroid Use Among Individuals Diagnosed with Allergic Rhinitis: Evidence from a Large Claims Database
AB108 Abstracts
410
SUNDAY
Patterns of Intranasal Corticosteroid Use Among Individuals Diagnosed with Allergic Rhinitis: Evidence from a Large Claims Database M. J. Lage1, G. N. Gross2, P. O. Buck3, M. Lepore3; 1HealthMetrics Outcomes Research, Groton, CT, 2Dallas Allergy and Asthma Center, Dallas, TX, 3Teva North America Branded Pharmaceuticals, Inc., Horsham, PA. RATIONALE: Examine patient characteristics and patterns of intranasal corticosteroid (INS) use among individuals diagnosed with allergic rhinitis (AR) from a large, retrospective claims database. METHODS: The i3 InvisionTM Data Mart was used from 1/1/2006 _12 years were included if they rethrough 12/31/2010. AR patients aged > ceived an aqueous formulation INS (with first such date identified as index date) and had continuous insurance coverage from 6 months before through 24 months after index date. Patients diagnosed with chronic rhinitis or nasal polyps were excluded. Data are descriptive in nature. RESULTS: The sample consisted of 163,473 individuals with a mean age of 41 (SD515), 59% female, and 55% residing in the southern US. Patients were most commonly prescribed generic fluticasone propionate (44%), mometasone (34%), or triamcinolone (10%) and had a high degree of related comorbidities, including sinusitis (40%), asthma (15%), and otitis media (12%). Treatment patterns during the first year after index date: a mean of 2.1 INS prescriptions were filled (median51.0; SD51.8), adherence as measured by the medication possession ratio averaged 18% (median58; SD516), and persistence averaged 135 days (median530; SD5134). Furthermore, 7% of patients switched INS products during their first year of use, with 5% of patients who initially received generic INS switching to a branded INS product. CONCLUSIONS: Although INS are considered the gold standard for symptomatic treatment of AR, this examination of a large claims database demonstrated that patients with AR who filled at least one aqueous formulation INS prescription generally did not use their INS for an extended period of time.
411
Comparison Of Patient Adherence To Intranasal Corticosteroids By Pressurized Metered-dose Inhaler Versus Aqueous Formulations M. Lepore1, D. Lang2, L. Cox3, C. S. Hankin4, Z. Wang4, A. Bronstone4, P. O. Buck1; 1Teva North America Branded Pharmaceuticals, Inc., Horsham, PA, 2Cleveland Clinic, Cleveland, OH, 3Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, 4 BioMedEcon, Moss Beach, CA. RATIONALE: Intranasal corticosteroids (INS) for allergic rhinitis (AR) treatment were previously available in ‘‘dry’’ pressurized metered-dose inhaler (pMDI) and aqueous (A-INS) formulations. While offering comparable efficacy, formulations differed by patient preference and tolerability. In 2003, following environmental concerns over propellants, pMDI were no longer marketed. New FDA-approved, environmentally-friendly pMDI formulations are anticipated. Using historical data, we assessed whether patient adherence (as proxy for patient preference and tolerability) significantly differed by INS formulation. METHODS: Matched (age at AR diagnosis, sex, race/ethnicity, allergyand non-allergy-related comorbidities), retrospective (7/1/1997-12/31/ _12 years, with newly2001) claims of Florida Medicaid enrollees, aged > _18 months of followdiagnosed AR, receiving de novo INS, and having > up compared pMDI versus A-INS groups by time and number of refills to discontinuation; percent maintaining 12-month therapy; percent with _70%); and refill gaps. ‘‘satisfactory compliance’’ (INS availability > RESULTS: Comparisons between matched patients receiving pMDI (N5195) versus A-INS (N5390) revealed no significant differences in median time and number of refills to discontinuation or percent of patients maintaining 12-month therapy. Significantly more patients receiving pMDI than A-INS achieved satisfactory compliance (33% versus 18%, p50.0091). Median refill gap was significantly shorter for pMDI versus A-INS patients (73 days versus 111 days, p50.0003). CONCLUSIONS: Patient preference and tolerability to INS, as measured by adherence-related outcomes, varied by formulation. Whereas no
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
significant differences were observed in time or number of refills to discontinuation and percent of patients maintaining 12-month therapy, significantly more pMDI than A-INS patients achieved satisfactory compliance, and refill gaps were significantly shorter for pMDI than for A-INS patients.
412
Evaluation of Coverage of Allergy Concepts in Electronic Health Records A. Yu, M. Ballow, A. Shvarts, H. Lehman; Division of Allergy and Immunology, Women and Children’s Hospital of Buffalo, SUNY-University at Buffalo, Buffalo, NY. RATIONALE: Increasing numbers of physicians are using electronic health records, as they are thought to have applications in facilitating communication, compliance with legal and financial requirements, evaluating provider performance, decision support, and data-mining in translational and clinical studies. Formal and computable representation of data and knowledge is fundamental in establishing a common vocabulary and semantics. In this study, we evaluated the coverage of the largest clinical terminology (SNOMED-CT). METHODS: Ten (10) allergy patient encounters from the Women and Children’s Hospital of Buffalo Pediatric Allergy clinic were parsed into discrete concepts. Each concept was classified as an allergy or general medicine concept. We used the National Center for Biomedical Ontology BioPortal search tool to search for matching SNOMED-CT concepts. The main outcome measure we used was adequacy of concept matching, based on a 3-point scale (0, no match; 1, partial match; 2, complete match). Findings from all encounters were combined, from which a mean coverage score was computed. RESULTS: After combining equivalent concepts, there were a total of 541 concepts parsed. For the combined 306 allergy concepts and 235 general medicine concepts, there were 310 complete matches, 188 partial matches, and 43 no matches (mean score51.4960.64). For allergy concepts, there were 148 complete matches, 130 partial matches, and 28 no matches. The mean coverage score for allergy concepts was 1.3960.65, while the mean score for general medicine concepts was 1.6260.60. CONCLUSIONS: More work is needed to improve coverage and semantics of the concepts covered in order to support primary and secondary uses of captured data.
413
Blunted Emotional Availability In Mothers Who Have Food Allergy Children :an Analysis By ''I Feel Pictures'' Test Y. Machino, M. Nagao, T. Fujisawa; Mie National Hospital, Tsu-City, JAPAN. RATIONALE: Food allergy in childhood is a significant burden not only on patients but also on their caregivers. Daily food avoidance and fear of anaphylaxis may negatively affect emotional state of the mothers and consequently impair mother-child relationship. METHODS: Forty-four mothers with food allergy children (FA moms) who visited allergy clinic and 35 mothers with healthy infants who visited well-baby clinic (WB moms) were enrolled. They completed the Japanese version of ‘‘I FEEL Pictures’’ test, a standardized test to evaluate caregivers’ emotional availability in the context of mother-child relationship. Mothers described their interpretation of infant emotion in free sentences by viewing 30 pictures of a 12-month old infant with various facial expressions. Then the answers by the mothers were categorized into 18 emotions including joy, fear, anger, sadness, anxiety, etc independently by two psychologists. Disagreement in categorization by the two was later settled through their discussion. Differences in interpretation of the pictures by the mothers were compared between the groups. RESULTS: FA moms rated significantly less number of pictures as ‘‘anger’’ than WB moms. Likewise, less number of pictures were rated as ‘‘sadness’’ and ‘‘pondering’’ by FA moms. There were no differences in number of pictures rated as ‘‘joy’’, ‘‘fear’’ and ‘‘anxiety’’. CONCLUSIONS: FA mom may be less sensitive to interpret emotions, especially negative ones, expressed by infants, suggesting possible emotional blunting caused by burden of food allergy.
410
SUNDAY
Patterns of Intranasal Corticosteroid Use Among Individuals Diagnosed with Allergic Rhinitis: Evidence from a Large Claims Database M. J. Lage1, G. N. Gross2, P. O. Buck3, M. Lepore3; 1HealthMetrics Outcomes Research, Groton, CT, 2Dallas Allergy and Asthma Center, Dallas, TX, 3Teva North America Branded Pharmaceuticals, Inc., Horsham, PA. RATIONALE: Examine patient characteristics and patterns of intranasal corticosteroid (INS) use among individuals diagnosed with allergic rhinitis (AR) from a large, retrospective claims database. METHODS: The i3 InvisionTM Data Mart was used from 1/1/2006 _12 years were included if they rethrough 12/31/2010. AR patients aged > ceived an aqueous formulation INS (with first such date identified as index date) and had continuous insurance coverage from 6 months before through 24 months after index date. Patients diagnosed with chronic rhinitis or nasal polyps were excluded. Data are descriptive in nature. RESULTS: The sample consisted of 163,473 individuals with a mean age of 41 (SD515), 59% female, and 55% residing in the southern US. Patients were most commonly prescribed generic fluticasone propionate (44%), mometasone (34%), or triamcinolone (10%) and had a high degree of related comorbidities, including sinusitis (40%), asthma (15%), and otitis media (12%). Treatment patterns during the first year after index date: a mean of 2.1 INS prescriptions were filled (median51.0; SD51.8), adherence as measured by the medication possession ratio averaged 18% (median58; SD516), and persistence averaged 135 days (median530; SD5134). Furthermore, 7% of patients switched INS products during their first year of use, with 5% of patients who initially received generic INS switching to a branded INS product. CONCLUSIONS: Although INS are considered the gold standard for symptomatic treatment of AR, this examination of a large claims database demonstrated that patients with AR who filled at least one aqueous formulation INS prescription generally did not use their INS for an extended period of time.
411
Comparison Of Patient Adherence To Intranasal Corticosteroids By Pressurized Metered-dose Inhaler Versus Aqueous Formulations M. Lepore1, D. Lang2, L. Cox3, C. S. Hankin4, Z. Wang4, A. Bronstone4, P. O. Buck1; 1Teva North America Branded Pharmaceuticals, Inc., Horsham, PA, 2Cleveland Clinic, Cleveland, OH, 3Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, 4 BioMedEcon, Moss Beach, CA. RATIONALE: Intranasal corticosteroids (INS) for allergic rhinitis (AR) treatment were previously available in ‘‘dry’’ pressurized metered-dose inhaler (pMDI) and aqueous (A-INS) formulations. While offering comparable efficacy, formulations differed by patient preference and tolerability. In 2003, following environmental concerns over propellants, pMDI were no longer marketed. New FDA-approved, environmentally-friendly pMDI formulations are anticipated. Using historical data, we assessed whether patient adherence (as proxy for patient preference and tolerability) significantly differed by INS formulation. METHODS: Matched (age at AR diagnosis, sex, race/ethnicity, allergyand non-allergy-related comorbidities), retrospective (7/1/1997-12/31/ _12 years, with newly2001) claims of Florida Medicaid enrollees, aged > _18 months of followdiagnosed AR, receiving de novo INS, and having > up compared pMDI versus A-INS groups by time and number of refills to discontinuation; percent maintaining 12-month therapy; percent with _70%); and refill gaps. ‘‘satisfactory compliance’’ (INS availability > RESULTS: Comparisons between matched patients receiving pMDI (N5195) versus A-INS (N5390) revealed no significant differences in median time and number of refills to discontinuation or percent of patients maintaining 12-month therapy. Significantly more patients receiving pMDI than A-INS achieved satisfactory compliance (33% versus 18%, p50.0091). Median refill gap was significantly shorter for pMDI versus A-INS patients (73 days versus 111 days, p50.0003). CONCLUSIONS: Patient preference and tolerability to INS, as measured by adherence-related outcomes, varied by formulation. Whereas no
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
significant differences were observed in time or number of refills to discontinuation and percent of patients maintaining 12-month therapy, significantly more pMDI than A-INS patients achieved satisfactory compliance, and refill gaps were significantly shorter for pMDI than for A-INS patients.
412
Evaluation of Coverage of Allergy Concepts in Electronic Health Records A. Yu, M. Ballow, A. Shvarts, H. Lehman; Division of Allergy and Immunology, Women and Children’s Hospital of Buffalo, SUNY-University at Buffalo, Buffalo, NY. RATIONALE: Increasing numbers of physicians are using electronic health records, as they are thought to have applications in facilitating communication, compliance with legal and financial requirements, evaluating provider performance, decision support, and data-mining in translational and clinical studies. Formal and computable representation of data and knowledge is fundamental in establishing a common vocabulary and semantics. In this study, we evaluated the coverage of the largest clinical terminology (SNOMED-CT). METHODS: Ten (10) allergy patient encounters from the Women and Children’s Hospital of Buffalo Pediatric Allergy clinic were parsed into discrete concepts. Each concept was classified as an allergy or general medicine concept. We used the National Center for Biomedical Ontology BioPortal search tool to search for matching SNOMED-CT concepts. The main outcome measure we used was adequacy of concept matching, based on a 3-point scale (0, no match; 1, partial match; 2, complete match). Findings from all encounters were combined, from which a mean coverage score was computed. RESULTS: After combining equivalent concepts, there were a total of 541 concepts parsed. For the combined 306 allergy concepts and 235 general medicine concepts, there were 310 complete matches, 188 partial matches, and 43 no matches (mean score51.4960.64). For allergy concepts, there were 148 complete matches, 130 partial matches, and 28 no matches. The mean coverage score for allergy concepts was 1.3960.65, while the mean score for general medicine concepts was 1.6260.60. CONCLUSIONS: More work is needed to improve coverage and semantics of the concepts covered in order to support primary and secondary uses of captured data.
413
Blunted Emotional Availability In Mothers Who Have Food Allergy Children :an Analysis By ''I Feel Pictures'' Test Y. Machino, M. Nagao, T. Fujisawa; Mie National Hospital, Tsu-City, JAPAN. RATIONALE: Food allergy in childhood is a significant burden not only on patients but also on their caregivers. Daily food avoidance and fear of anaphylaxis may negatively affect emotional state of the mothers and consequently impair mother-child relationship. METHODS: Forty-four mothers with food allergy children (FA moms) who visited allergy clinic and 35 mothers with healthy infants who visited well-baby clinic (WB moms) were enrolled. They completed the Japanese version of ‘‘I FEEL Pictures’’ test, a standardized test to evaluate caregivers’ emotional availability in the context of mother-child relationship. Mothers described their interpretation of infant emotion in free sentences by viewing 30 pictures of a 12-month old infant with various facial expressions. Then the answers by the mothers were categorized into 18 emotions including joy, fear, anger, sadness, anxiety, etc independently by two psychologists. Disagreement in categorization by the two was later settled through their discussion. Differences in interpretation of the pictures by the mothers were compared between the groups. RESULTS: FA moms rated significantly less number of pictures as ‘‘anger’’ than WB moms. Likewise, less number of pictures were rated as ‘‘sadness’’ and ‘‘pondering’’ by FA moms. There were no differences in number of pictures rated as ‘‘joy’’, ‘‘fear’’ and ‘‘anxiety’’. CONCLUSIONS: FA mom may be less sensitive to interpret emotions, especially negative ones, expressed by infants, suggesting possible emotional blunting caused by burden of food allergy.