Impact of Asthma Controller Medications on Clinical, Economic, and Patient-Reported Outcomes

OBJECTIVE: To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications. PATIENTS AND METHODS: This observational study, which used c administrative claims data from US commercial health plans, Included patients with asthma aged 18 through 64 years who filled a prescription for at least 1 asthma controller medication from September 1, 2003, through August 31, 2005. Outcome metrics Included the use of short-acting beta-agonists (SABAs), the use of oral corticosteroids, Inpatient (INP)/emergency department (ED) visits, and asthma-related health care costs. A subset of 5000 patients was randomly selected for a survey using the Mini-Asthma Quality of Life Questionnaire, the Work Productivity and Activity Impairment questionnaire, and the Asthma Therapy Assessment Questionnaire. RESULTS: Of 56,168 eligible patients, 823 returned completed questionnaires. Compared with Inhaled corticosteroids (ICSs), leukotriene modifiers (LMs) were associated with lower odds of INP/ED visits (odds ratio [OR], 0.80; P <.001), lower odds of using 6 or more SABA canisters (OR, 0.81; P <.001), and higher annual cost ($193; P <.001). In the subgroup analysis of adherent patients, LMs were associated with higher odds of INP/ED visits (OR, 1.74; P=.04), lower odds of using 6 or more SABA canisters (OR, 0.46; P <.001), and higher annual cost ($235; P <.001). Inhaled corticosteroids and LMs had a comparable Impact on all patient-reported outcomes. For combination therapy, ICS plus a long-acting beta-agonist consistently showed at least equivalent or better outcomes In the use of SABAs and oral corticosteroids, the risk of INP/ED visits, cost, asthma control level, quality of life, and Impairment In productivity and activity. CONCLUSION: Inhaled corticosteroids were associated with a lower risk of INP/ED visits, and a lower cost If adherence was achieved. When adherence cannot be achieved, LMs may be a reasonable alternative. Combination therapy with ICS plus a long-acting P-agonist was associated with better or equivalent clinical, economic, and patient-reported outcomes.