George Rust1, Shun Zhang, Luceta McRoy, Maria Pisu. 1. National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310. E-mail: GRust@msm.edu.
Abstract
BACKGROUND: Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx). OBJECTIVES: We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children. STUDY DESIGN: We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007. METHODS: Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%. RESULTS: Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence. CONCLUSIONS: If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma.
BACKGROUND: Many asthma-related exacerbations could be prevented by consistent use of daily inhaled corticosteroid therapy (ICS-Rx). OBJECTIVES: We sought to measure the potential cost savings that could accrue from increasing ICS-Rx adherence in children. STUDY DESIGN: We measured observed costs for a cohort of 43,156 Medicaid-enrolled children in 14 southern states whose initial ICS-Rx was prescribed in 2007. METHODS: Adherence rates and associated costs were calculated from Medicaid claims. Children were categorized as high or low adherence based on the ratio of ICS-Rx claims filled to total asthma drug claims. Branching tree simulation was used to project the potential cost savings achieved by increasing the proportion of children with ICS-Rx to total asthma Rx ratios greater than 0.5 to 20%, 40%, 60%, 80%, and 100%. RESULTS: Increasing the proportion of children who maintain higher adherence after initial ICS-Rx to 40% would generate savings of $95 per child per year. An intervention costing $10 per member per month that resulted in even half of the children maintaining high adherence would generate a 98% return on investment for managed care plans or state Medicaid programs. Net costs decreased incrementally at each level of increase in ICS-Rx adherence. The projected Medicaid cost savings for these 14 states in 2007 ranged from $8.2 million if 40% of the children achieved high adherence, to $57.5 million if 80% achieved high adherence. CONCLUSIONS: If effective large-scale interventions can be found, there are substantial cost savings to be gained from even modest increases in real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma.
Authors: Edward C F Wilson; Erika J Sims; Stanley D Musgrave; Lee Shepstone; Annie Blyth; Jamie Murdoch; H Miranda Mugford; Elizabeth F Juniper; Jon G Ayres; Stephanie Wolfe; Daryl Freeman; Richard F T Gilbert; Ian Harvey; Elizabeth V Hillyer; David Price Journal: Pharmacoeconomics Date: 2010 Impact factor: 4.981
Authors: David E Capo-Ramos; Catherine Duran; Alan E Simon; Lara J Akinbami; Kenneth C Schoendorf Journal: J Asthma Date: 2014-03-20 Impact factor: 2.515
Authors: Wayne J Morgan; Ellen F Crain; Rebecca S Gruchalla; George T O'Connor; Meyer Kattan; Richard Evans; James Stout; George Malindzak; Ernestine Smartt; Marshall Plaut; Michelle Walter; Benjamin Vaughn; Herman Mitchell Journal: N Engl J Med Date: 2004-09-09 Impact factor: 91.245
Authors: Ellen F Crain; Michelle Walter; George T O'Connor; Herman Mitchell; Rebecca S Gruchalla; Meyer Kattan; George S Malindzak; Paul Enright; Richard Evans; Wayne Morgan; James W Stout Journal: Environ Health Perspect Date: 2002-09 Impact factor: 9.031
Authors: Elham Hossny; Nelson Rosario; Bee Wah Lee; Meenu Singh; Dalia El-Ghoneimy; Jian Yi Soh; Peter Le Souef Journal: World Allergy Organ J Date: 2016-08-12 Impact factor: 4.084
Authors: Iida Vähätalo; Pinja Ilmarinen; Leena E Tuomisto; Minna Tommola; Onni Niemelä; Lauri Lehtimäki; Pentti Nieminen; Hannu Kankaanranta Journal: ERJ Open Res Date: 2020-03-23