Appropriate use of inhaled corticosteroid and long-acting ß₂-adrenergic agonist combination therapy among asthma patients in a US commercially insured population

ABSTRACT

Objective: To examine health care utilization measures indicating which asthma patients are appropriate for inhaled corticosteroid and long-acting ß₂-adrenergic agonist (ICS/LABA) therapy and determine whether two ICS/LABA therapies were initiated in accordance with guidelines.

Research design and methods: A retrospective cohort study of commercially insured asthma patients aged ≥12 years that initiated fluticasone propionate/salmeterol (FSC) or budesonide/formoterol fumarate dihydrate (BFC) combination therapy in 2007 was conducted. Use was considered appropriate if patients met any of the following during a 1-year period before ICS/LABA initiation: ICS or leukotriene receptor antagonist (LTRA) use; an asthma-related emergency department (ED) visit or hospitalization; ≥2 oral corticosteroids (OCS) courses; or ≥6 short-acting β₂-adrenergic agonist (SABA) canisters. Multivariate logistic regression was used to assess factors associated with appropriate ICS/LABA use. Certain limitations inherent to the use of claims data for research apply to this study.

Results: Of 24,231 patients who initiated ICS/LABA therapy, 993 received BFC and 23,238 received FSC. Among all patients, 37.6% met ≥1 criteria for appropriate use. However, compared with FSC users, BFC users had a significantly higher likelihood of meeting ≥1 of these criteria (odds ratio, 2.01; 95% CI, 1.76–2.30; p < 0.001), and a higher proportion of BFC than FSC patients met 4 of the 5 appropriate use criteria. In total, 58.4% of BFC patients versus 36.7% of FSC patients met ≥1 criteria for appropriate use. Other factors associated with appropriate use included age, region, Charlson comorbidity score, number of medications, and prescriber specialty.

Conclusion: Fewer than half of all patients fulfilled the specified criteria for being appropriate for ICS/LABA therapy. However, a significantly higher proportion of BFC than FSC users met the criteria for appropriate use of ICS/LABA therapy. These results may suggest a need for improved physician awareness of consensus guidelines for the initiation of ICS/LABA therapy.

Keywords: :

• Appropriateness criteria
• Asthma
• Guidelines
• Inhaled corticosteroid
• Long-acting β₂-adrenergic agonist
• Retrospective analysis

Transparency

Declaration of funding

This study was funded by AstraZeneca LP, Wilmington, DE, USA.

Declaration of financial and other relationships

B.G. has disclosed that he is employed by AstraZeneca and owns stock in the company. C.B. has disclosed that he has received research funding from AstraZeneca and GlaxoSmithKline, and has served as a consultant for AstraZeneca and other pharmaceutical companies. X.Y., V.Z. and M.N. have disclosed that they are employed by i3 Innovus, which has been contracted by AstraZeneca to conduct this study.

All peer reviewers receive honoraria from CMRO for their review work. Both peer reviewers have disclosed that they have no relevant financial relationships.

Acknowledgment

Editorial support was provided by Jesse Potash and Marissa Buttaro at Scientific Connexions, and was funded by AstraZeneca LP.

Notes

* Symbicort Inhalation Aerosol is a registered trade name of AstraZeneca LP, Wilmington, DE, USA

† Advair is a registered trade name of GlaxoSmithKline, Research Triangle Park, NC, USA