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Permanent Link: http://ufdc.ufl.edu/IR00002501/00001
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Title: Prescribing Long-Acting Beta-Agonists as Monotherapy to Adults with Controlled and Uncontrolled Asthma
Physical Description: Conference Papers
Creator: Ayad K. Ali
Conference: ISPOR 18th Annual International Meeting
Publisher: ISPOR
Place of Publication: Lawrenceville, NJ, USA
Publication Date: May 1, 2013
 Notes
Abstract: OBJECTIVES: To describe demographic and health care utilization characteristics of adults with asthma who initiated inhaled long-acting beta-agonist (LABA) bronchodilators as monotherapy. METHODS: A cohort of asthmatic adults with controlled and uncontrolled asthma in the General Practice Research Database was retrospectively followed to compare the propensity of initiating inhaled LABA monotherapy versus any other inhaled controller medication_inhaled corticosteroids (ICS) monotherapy or ICS/LABA combination therapy. Patients with controlled asthma are defined as not having >2 asthma drug classes or any short-acting beta-agonists (SABA) prescribed at the LABA prescribing date; and not having any of the following during 12 months before LABA prescribing date: prescription for oral corticosteroids, >6 prescriptions for SABA, or attending emergency departments or hospitalization for asthma. RESULTS: Among the 51,103 patients aged 13-65 who met the inclusion criteria, 60% were uncontrolled asthmatics and 40% had controlled asthma. the majority of patients in both groups were nonsmoking obese females who visited general practices in England. Patients with controlled asthma were more likely to receive LABA monotherapy than patients with uncontrolled asthma (OR=2.22, 95%CI=1.90-2.59). Asthmatics who were prescribed leukotriene receptor antagonists (LTRA) were at risk of receiving add-on LABA (OR=7.90, 95%CI=4.27- 13.53). General practices in England were less likely to prescribe LABA monotherapy than practices in Scotland, Wales, or Northern Ireland. Consultations ≤10 minutes were associated with 38% higher likelihood of prescribing LABA monotherapy inhalers than visits with longer duration. CONCLUSIONS: Adults with controlled asthma who are ICS-naïve are more likely to initiate LABA monotherapy than patients with uncontrolled asthma; however, LABA is prescribed as an add-on therapy to anti-inflammatory LTRA in controlled asthmatics.
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Ayad Ali.
Publication Status: Published
General Note: Suggested Citation: • Ali AK, Hartzema AG. Prescribing Long-Acting Beta-Agonists as Monotherapy to Adults with Controlled and Uncontrolled Asthma. Value in Health. 2013:16(3):A241 Abstract No. PRS54
 Record Information
Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: Applicable rights reserved.
System ID: IR00002501:00001


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VALUE IN HEALTH 16 (2013) A1-A298 A241 (same dose FSC). Patient demographics included comorbidity, albuterol use, asthma-related health care utilization, number of controllers, number oral corticosteroids, number of physician visits, specialist visits, season, time to stepdown and FSC fill rate. Multivariate analysis was performed to determine the characteristics related to each step-down. RESULTS: Presence of a specialist visit [adjusted Odds Ratio (OR) 1.92, 95% CI 1.77-2.52 and OR 1.47, 95% CI 1.31-1.85] and more physician visits (OR=1.16, 95% CI: 1.11-1.28, and OR, 1.17 95% CI 1.11-1.28) prior to step-down were significantly associated with step-down of therapy for both low dose FSC (n=1,459), and ICS monotherapy (n=1,775) respectively. CONCLUSIONS: Subjects with close assessment of asthma disease and specialist care may be more likely to step-down from FSC therapy. PRS53 UTILIZATION PATTERN OF RESPIRATORY MEDICATIONS AMONG CHRONIC OBSTRCTIVE PULMONARY DISEASE PATIENTS IN TAIWAN Lin HW1, Yu IW2, Cheng WE2 1China Medical University, Taichung, Taiwan, 2China Medical University Hospital, Taichung, Taiwan OBJECTIVES: Incidence of chronic obstructive pulmonary disease (COPD) has increased globally. The respiratory medications were the main treatment strategies to control for COPD disease progression. The purpose of the current study was to explore the utilization pattern of respiratory medications among COPD patients in Taiwan. METHODS: A retrospective observational study was conducted by using 2000 and 2005 Long itudinal Health Insurance Databases (two million random samples). A cohort of national health insurance beneficiaries with any newly diagnosis for COPD ( International Classification of Diseases, Ninth Revision [ICD-9] codes=491.x, 492.x, 496) in 2006 and aged greater than 40-year-old was identified. These COPD patients were assessed and followed for one-year from the date of their first prescription of any inhaled COPD medications (index date) and their persistence of each class of COPD medications was evaluated. RESULTS: A cohort of 7838 new COPD cases was identified in 2006. They were about 68.912.6 years old and male was predominant (67%). Of all, 95% were coded with 496. However, only 579(6.9%) were ever prescribed with inhaled COPD medications in 2006. The days to the first prescription of inhaled COPD medications after diagnosis were 26 days in average, and up to 336 days. Only 5.5% to 19% of patients continued on the index drug for more than 6 months, which decreased to 1 to 5% at 12 month s. The long-acting muscarinic antagonist (LAMA) showed the highest persistence among the other medications, whereas inhaled corticosteroid (ICS) had the lowest. CONCLUSIONS: Respiratory medications were obviously under-utilized in Taiwanese patients with COPD. Further study is needed to explore the consequence of such phenomenon and its potential resolutions. PRS54 PRESCRIBING LONG-ACTING BETA-AGONISTS AS MONOTHERAPY TO ADULTS WITH CONTROLLED AND UNCONTROLLED ASTHMA Ali AK1, Hartzema AG2 1Eli Lilly and Company, Indianapolis, IN, USA, 2University of Florida, Gainesville, FL, USA OBJECTIVES: To describe demographic and health care utilization characteristics of adults with asthma who initiated inhaled long-acting beta-agonist (LABA) bronchodilators as monotherapy. METHODS: A cohort of asthmatic adults with controlled and uncontrolled asthma in the General Practice Research Database was retrospectively followed to compare the propensity of initiating inhaled LABA monotherapy versus any other inhaled controller medication_inhaled corticosteroids (ICS) monotherapy or ICS/LABA combination therapy. Patients with controlled asthma are defined as not having >2 asthma drug classes or any short-acting beta-agonists (SABA) prescribed at the LABA prescribing date; and not having any of the following during 12 months before LABA prescribing date: prescription for oral corticosteroids, >6 prescriptions for SABA, or attending emergency departments or hospitalization for asthma. RESULTS: Among the 51,103 patients aged 13-65 who met the inclusion criteria, 60% were uncontrolled asthmatics and 40% had controlled asthma. the majority of patients in both groups were nonsmoking obese females who visited general practices in England. Patients with controlled asthma were more likely to receive LABA monotherapy than patients with uncontrolled asthma (OR=2.22, 95%CI=1.90-2.59). Asthmatics who were prescribed leukotriene receptor antagonists (LTRA) were at risk of receiving add-on LABA (OR=7.90, 95%CI=4.2713.53). General practices in England were less likely to prescribe LABA monotherapy than practices in Scotland, Wales, or Northern Ireland. Consultations 10 minutes were associated with 38% higher likelihood of prescribing LABA monotherapy inhalers than visits with longer duration. CONCLUSIONS: Adults with controlled asthma who are ICS-nave are more likely to initiate LABA monotherapy than patients with uncontrolled asthma; however, LABA is prescribed as an add-on therapy to anti-inflammatory LTRA in controlled asthmatics. PRS55 RACIAL AND ETHNIC DISPARITY IN SMOKING CESSATION MEDICATION USE AMONG ADULT SMOKERS IN THE UNITED STATES Wang X1, Abughosh S2 1Universtiy of Houston, Houston, TX, USA, 2University of Houston, Houston, TX, USA OBJECTIVES : To examine racial/ethnic disparity in smoking cessation medication use among adult smok ers in the United States. METHODS: A retrospective cross-sectional study was conducted using the Medical Expenditure Panel Survey (MEPS) data (2009). The study included adults aged 18 years who self-reported currently using tobacco. The outcome variable was receiving smoking cessation medication use versus not. Andersen's Behavioral Model of Health Services Utilization wa s used as the conceptual framework. The independent variables were categorized into predisposing, enabling, and need characteristics, including age, gender, race, marital status, education, insurance status, family income, region, urban residence, usual source of health care, general health status, comorbidity, obesity, activities of daily living. Descriptive statistics and chi-square tests were used to examine group differences. Multivariate logistic regression analysis was performed to investigate racial/ethnic disparity in smoking cessation medication use. RESULTS: Total sample was 39,900,131and mostly comprised of Non-Hispanic Whites (73.38%), followed by Non-Hispanic Black (12.20%), Hispanics (9.53%), and others (4.88%). Race was a significant predictor of sm oking cessation medication use. The findings indicated that Non-Hispanic Blacks were less likely to use smoking cessation medication compared to Non-Hispanic Whites (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.19-0.80). Smokers who live in South were less likely to use smoking cessation medication compared with those who live in Northeast (OR: 0.43, 95% CI: 0.20-0.93). Obese people were more likely to use smoking cessation medication compared to non-obese smokers (OR: 2.68, 95% CI: 1.69-4.27). Additionally, urban residence was a significant predictor of smoking cessation medication use (OR: 2.26, 95% CI: 1.17-4.39). CONCLUSIONS: While smoking cessation remains highly recommended for all smokers, Black smokers are less likely to use smoking cessation medications compared to White. Further research is needed to understand the reasons for this disparity and find ways to eliminate it. PRS56 ASSESSMENT OF PHYSICIANS' KNOWLEDGE AND PERCEPTIONS TOWARDS MEDICINE QUALITY AND PRICES IN KABUL, AFGHANISTAN Bashaar M, Hassali MA Universiti Sains Malaysia, Penang, Malaysia OBJECTIVES: The current study is aimed to assess the knowledge and perceptions of physicians towards medicine quality and prices in Kabul City. METHODS: In this cross-sectional descriptive survey, a total of 400 physicians were approached to be part of the survey and 347 consented to participate (response rate of 86.7%). RESULTS: In the survey, 36.6% of physicians felt that the quality of imported medicine is good, and 50.8% often felt that medicines given by public hospitals are of high quality. Howe ver 40.6% disagreed that the Afghan Drug Regulatory Authority controls quality of medicine registered in the country. Overall, 85.6% of respondents felt that the government should adopt health policies to control the medicine prices and expenditures, and 76.3% reported that higher medicine costs negatively impacts patient outcomes. Only 45% reported that doctors have poor understandings on medicine prices, and 84.5% reported that the medicine prices both in the government and private should be made public. Among the respondents, 26.3% felt that medicine prices are affordable to their patients. A high proportion of the respondents (85.2%) agreed that prescription medicine prices must be regulated by the government since 70.3% of physicians reported that medicine prices are high in private hospitals. About 60.5% of the physicians felt that medicine prices influence the ir prescribing decision, and 65.8% agreed that the patients income influences their prescribing decisions. CONCLUSIONS: Results suggest that physicians must be costconscious and alert in their prescriptions and do not undermine the cost of medication. As a conclusion, the Afghan Drug Regulatory Authority should control the medicine prices and quality on a regular basis in the market, which will act as leverage for sustainable and effective treatment and access to essential medicines. Further, the study suggests that there is substantial room for improvement in the knowledge of physicians about medicine quality and prescription cost. PRS57 COMPARISON OF DIAGNOSIS BASED COMORBIDITY INDICES TO PREDICT HIGH COST COPD PATIENTS PROSPECTIVELY Mhatre SK, Aparasu RR, Johnson ML University of Houston, Houston, TX, USA OBJECTIVES: High health care costs are incurred by Chronic Obstructive Pulmonary Disease (COPD) patients. Identifying high cost patients prospectively benefits health care providers and insur ance companies. The purpose of the current study was to compare the performance of generic and COPD specific diagnosis based comorbidity measures in predicting high medical expenditures in COPD patients. METHODS: A longitudinal study was conducted using nationally representative data from the Medical Expenditure Panel Survey. Prediction models were developed using cohorts initiated in 2008-2009 and validated using cohorts initiated in 2006-2007. Logistic regression was used to predict being in the upper expenditure decile in year 2, using data from year 1. Three comorbidity measures were compared: DHoore Charlson comorbidity index, Elixhauser comorbidity index and COPD specific comorbidity Test (COTE). Models were evaluated using c-statistics, Hosmer-Lemeshow statistic, correlation coefficient and positive prediction value. RESULTS: Comorbidity indices improved prediction of high cost COPD patients beyond age and gender, with the Elixhauser index pr oviding the best prediction (c-statistic: 0.82), followed by COTE (c-statistic: 0.74). The Hosmer-Lemeshow test for both was also non-significant, indicating high accuracy. The COTE index had the best external validation properties (c-statistics: 0.66, Hosmer-Lemeshow: 7.4), followed by Elixhauser index (c-statistics: 0.61, Hosmer-Lemeshow: 12.1). In both learning and testing models, the difference in c-statistics of Elixhauser and COTE models was non-significant (learning, z=1.53 and testing, z=0.12), indicating that both measures do not differ in their discriminative power. CONCLUSIONS : Both, Elixhauser index and the COPD specific COTE index can best predict high costs in COPD patients and inclusion of either of them in risk adjustment models will be valuable in managing high cost COPD patients. PRS54 PRE SC RIBIN G L O N G -A C TI NG BETA-A GO NI S T S A S M O N O THERAPY T O AD U LT S WITH CONTROLLED AND UNCONTROLLED ASTHMA Suggested Citation: Ali AK, Hartzema AG. Prescribing Long-Acting Beta-Agonists as Monotherapy to Adults with Controlled and Unc ontrolled Asthma. Value in Health. 2013:16(3):A241 [No. PRS54]