Cost implications for the use of inhaled anti-inflammatory medications in the treatment of asthma.

OBJECTIVE: To compare the expected costs of treating patients with asthma with versus without inhaled anti-inflammatory medications, adjusting for other factors that also influence medical care expenditures. DESIGN: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures and treatment with inhaled corticosteroids, sodium cromoglycate (cromolyn) or nedocromil. The regressions adjusted for differences in patients' demographics, location, plan type and severity of illness. SETTING: Large, self-insured, corporate-sponsored medical plans represented in MarketScan database. PATIENTS AND PARTICIPANTS: 7466 continuously enrolled patients with asthma. INTERVENTIONS: Treatment with inhaled corticosteroids, sodium cromoglycate or nedocromil. MAIN OUTCOME MEASURES: (i) Total inpatient, outpatient and pharmaceutical expenditures; and (ii) asthma-related expenditures in the 1996 calendar year. RESULTS: If all patients had been treated with inhaled anti-inflammatory drugs, total expenditures would be expected to be about $US944.82 per patient lower, on average, than would be the case if no patients received these drugs. Asthma-related expenditures would be about $US498.74 per patient higher, on average, if all patients were treated with these drugs. CONCLUSIONS: Using inhaled anti-inflammatory agents would be associated with higher asthma-related expenditures but lower total expenditures. Treatment with inhaled anti-inflammatory drugs may represent an investment in better care that pays off with better health and lower total medical care expenditures.

Short-run associations between medical care expenditures and adherence to clinical practice guideline-based measures for diabetes.

OBJECTIVES: To estimate relationships between medical care expenditures in 1996 and adherence to seven guideline-based measures for diabetes. METHODS AND DATA: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures in 1996 and adherence to guideline-based measures that year, adjusting for differences in patients' demographics, location, plan type, and severity of illness. Adherence to criteria regarding physician visits, eye exams, blood sugar tests, urinalysis, triglyceride tests, total cholesterol tests, and HDL cholesterol tests was studied for 18,403 patients in 35 health plans. RESULTS: Average total medical expenditures would be $713 higher if all patients were treated according to the guideline-based measures in 1996, compared to what expenditures would be if no patients were treated that way. Average diabetes-related expenditures would be about $322 higher. Two important exceptions to this pattern were for adherence to the suggested frequency of hemoglobin A1c blood sugar tests and ophthalmology visits for dilated eye exams. Having the recommended number of these tests was associated with significantly lower total expenditures. CONCLUSIONS: In general, adherence to clinical practice guideline-based measures was more costly than deviating from those criteria, in the short-run. Perhaps expenditures should be higher for many patients who are not treated according to guidelines. Randomized studies with more years of follow-up should be conducted to assess whether short-term investments in guideline adherence pay off with lower medical expenditures and greater levels of health in the long term.