Evaluation of the ’sophia’ asthma patient management program at two years

Abstract

Abstract Objectives To evaluate the impact of a multi-faceted management support program deployed towards asthma patients by the French Health Insurance since February 2015 in 19 (20%) French pilot areas. Methods The population is composed of subjects aged 18 to 40 years in 2014, with at least 3 asthma medication deliveries in 2012 as well as in 2013 that were identified and followed-up within the SNDS French claims database. A controlled before-and-after design was used for assessing program impact. Unexposed subjects (i.e. living in non-pilot areas) were matched with exposed subjects (i.e. living in pilot areas) on a propensity score. Adherence to controller treatment (inhaled corticoids), measured by the medication refill adherence MRA, was the primary outcome. Secondary outcomes were medications and heathcare use, sick leaves, exacerbations, costs. Results Analysis concerned 29, 746 matched-pairs. With a baseline mean MRA of 40.17% in unexposed subjects, the difference-in-difference was non-significant (0.26%, p = 0.545). However, the program showed a significant impact on the percentage of subjects that moved to a better MRA category or maintained a high adherence (OR = 1.05,p=0.028). The program had no significant impact on the other secondary outcomes. In planned secondary analyses comparing the 11.5% exposed subjects who adhered to the program to their matched-unexposed subjects, the difference-in-difference showed a program impact on specialist consultations, asthma-related and all medication costs, and total asthma-related costs. However, results on this subpopulation must be examined with caution since the matching procedure couldn’t take into account the propensity to adhere. Conclusions Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution. Key messages Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.