Asthma costs and utilization in a managed care organization

Background: Medical costs and health care utilization associated with asthma and the variation by treatment are poorly understood. Objective: To compare single controller inhaled corticosteroid (ICS) to other asthma drug regimens on medical costs and utilization. Methods: Direct medical costs and utilization were captured from administrative electronic databases from continuously enrolled members with asthma age 5 years or older with drug coverage. Asthma patients were identified during 2002, categorized into 14 asthma drug groups on the basis of 2003 prescription records, and had total medical costs and utilization determined in 2004 adjusting for demographics, insurance types, asthma risk, comorbidity, and propensity scores. Results: A total of 96,631 patients met the study eligibility criteria. Patients were (mean +/- SD) age 38 +/- 23 years and were 57% female, 14% Medicare, 4% Medicaid, and had a median family income (mean +/- SD) of $64,967 +/- $29,285. Total unadjusted direct medical costs/patientlyear averaged $3745 ($3298 low asthma risk vs $6797 high asthma risk; P <.001). Adjusted total and asthma drug costs were significantly lower with single controller ICS compared with single controller leukotriene modifiers, long-acting beta-agonists, and theophylline and most combination controller regimens (P <.001 for all comparisons). In addition, single controller ICS compared with single controller leukotriene modifiers and combination controllers was associated with significantly lower asthma-related utilization. Conclusion: Total direct costs and asthma-related utilizations are meaningfully less in the year after being dispensed single controller ICS compared with single controller leukotriene modifiers or most combination controllers.