- Drug Benefit Trends Vol 21 No 4
- Volume 21
- Issue 4
Medication Persistence and Health Care Expenditures in a Managed Medicaid Population With Asthma
A retrospective review of administrative claims data was conducted to identify health plan members with asthma who were persistent with their controller medications and those who were not persistent. Utilization of health care services and associated costs were measured for both groups. Non-persistent use of controller medications resulted in more asthma-related emergency department visits and home health services whereas persistent controller use was associated with more physician office and outpatient visits. Mean asthma-related medical costs per member were greater in the non-persistent cohort ($577.62) than in the persistent cohort ($323.03). These findings support the need for targeted interventions to address non-persistence in a managed Medicaid population.(Drug Benefit Trends. 2009;21:112-118)
Asthma affects approximately 22 million persons in the United States, costing an estimated $19.7 billion annually. Of the $14.7 billion in direct costs, $8.5 billion (approximately 60%) is attributed to the cost of hospitalizations and emergency department (ED) visits. Prescription drugs represent the remaining 40% of direct costs or $6.2 billion.1 Persons with asthma have more than 444,000 hospitalizations and 1.7 million ED visits annually. In addition, in 2006, there were 11.8 million outpatient asthma visits to physician offices and hospital outpatient departments.
Although mortality from asthma has declined in recent years, in 2005, there were 3884 deaths due to asthma.2 Much of the morbidity and mortality associated with asthma can be prevented with persistent use of long-term controller medications, such as inhaled corticosteroids. Unfortunately, controller medications are significantly underused, with reports of underuse as high as 73%.3 Nonadherence to effective therapies accounts for approximately 60% of asthma-related hospitalizations,4 with asthma ranked as the third leading cause of preventable hospitalizations in the United States.5
Other factors associated with increased mortality and morbidity related to asthma are lower socioeconomic status, African American race, and residence in urban areas.6 Data suggest children from low-income families have a 40% higher rate of hospitalizations and a 40% lower rate of preventive ambulatory care.7 Studies of Medicaid recipients also report findings of increased hospitalization rates3 and underuse of controller medications.8 Proposed reasons for these disparities include lack of access to quality care, inability to afford care, and cultural and language barriers.3,6 However, findings that suggest lack of access to quality care is the primary contributor to increased morbidity are not conclusive.6
Kentucky, where this study was conducted, has a high prevalence of asthma, smoking (28.2% of the population smokes), and cancer (226.2 cancer deaths per 100,000 population in 2008), and it ranks as having one of the highest rates for utilizing medical services.9 Approximately 16.9% of the population lives in poverty, which is above the national average.10
Passport Health Plan is a provider-owned Medicaid Managed Care program serving approximately 21% of the Kentucky Medicaid population. Its 150,483 members are mainly young, female, and low- income, residing in 16 Kentucky counties surrounding the metropolis of Louisville. The objectives of this study were to determine the rate of persistence with asthma controller medications, to identify members non-persistent with asthma controller medications who may benefit from targeted disease management interventions, and to examine the influence of medication persistence on the utilization of health care resources among persons with asthma who are enrolled in a Medicaid managed care plan.
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