Costs and Utilization Patterns Associated With Persistent Asthma: A Comparison of Texas Medicaid Patients With and Without Continuous Inhaled Corticosteroid Treatment

Abstract

OBJECTIVE: To compare the change in Texas Medicaid prescription and medical payments and utilization patterns between asthma patients continuously treated with inhaled corticosteroids (SG) and asthma patients continuously treated with therapies other than inhaled corticosteroids (NSG). DESIGN: A retrospective 1:3 matched cohort was created by analyzing Texas Medicaid database claims made between March 1996 and June 1998. PATIENTS: Patients, regardless of age, who (1) were eligible for Medicaid benefits during an 18-month period; (2) had a diagnosis for asthma; and (3) had continuous use of asthma medications during the 18-month period. RESULTS: Profiles for 396 patients (99 treated with inhaled corticosteroids, 297 treated with other therapies) were analyzed. Post-steroid monthly prescription payments were higher for the SG compared to the NSG, but a decrease in medical payments in the SG offset this increase, so that overall Medicaid payments were similar between the groups. All types of medical visits (clinic, emergency department [ED], hospitalizations) increased for the NSG during the post-index phase, whereas these visits decreased for the SG patients. The number of ED visits was cut in half after the addition of inhaled corticosteroids among the SG, while the number of ED visits nearly doubled among the NSG. Contrary to findings of previous studies, in this study the patient's first inhaled corticosteroid was prescribed by a general practitioner almost 70% of the time. CONCLUSIONS: Although prescription payments increased for the SG, the number of medical visits and their cost decreased enough to offset this increase. A decrease in medical visits, especially for acute care, may indicate better outcomes for the Medicaid patients with no increase in overall cost.