Characterizing the severe asthma population in the United States: claims-based analysis of three treatment cohorts in the year prior to treatment escalation

<div><p></p><p><i>Objectives</i>: Little is known about the disposition of severe patients prior to treatment escalation. To classify patients by treatment step using pharmacy data and describe their economic and healthcare utilization, insurance status, and sociodemographic characteristics in the year prior to escalation to Global Initiative for Asthma (GINA) steps 4 and 5. <i>Methods</i>: This was a retrospective claims cohort study of asthma patients (age 12–75 years) newly initiated on “stable therapy” (three consecutive months of therapy) with omalizumab, high intensity corticosteroids (HICS; ≥1000 µg/d inhaled fluticasone equivalent or oral prednisone), or high-dose inhaled corticosteroid (HDICS; ≥500–<1000 µg/d fluticasone equivalent) from 2002 to 2011. Other asthma treatments were compared as a reference. <i>Results</i>: Of 25 297 patients, 856 initiated omalizumab, 6926 initiated HICS, and 11 445 initiated HDICS. In the year prior to treatment escalation to omalizumab, HICS, and HDICS, respectively, individuals had high annual mean medical expenditures ($14 071,$12 030, and $7570), utilization (27 outpatient and 10 specialty care visits; 19 outpatient and three specialty; 15 outpatient and two specialty), asthma-related prescription drugs (11.74, 7.8, and 5.17) and chronic comorbidities (2.68, 2.67, and 2.19). Prior to omalizumab treatment, patients were more likely to be salaried, full-time employees with commercial PPO/POS insurance. <i>Conclusions</i>: Prior to escalating treatment to GINA steps 4 and 5, individuals experienced significant annual medical expenditures, healthcare resource utilization and polypharmacy burden, which may reflect poorly controlled asthma and the need to escalate treatment. Medical claims data and utilization-based measures may be helpful in classifying individuals by GINA treatment step.</p></div

Technical_Appendix – Supplemental material for Economic Value of Improved Accuracy for Self-Monitoring of Blood Glucose Devices for Type 1 and Type 2 Diabetes in England

<p>Supplemental material, Technical_Appendix for Economic Value of Improved Accuracy for Self-Monitoring of Blood Glucose Devices for Type 1 and Type 2 Diabetes in England by Robert Brett McQueen, Marc D. Breton, Joyce Craig, Hayden Holmes, Melanie D. Whittington, Markus A. Ott and Jonathan D. Campbell in Journal of Diabetes Science and Technology</p

Program costs of emergency department nontargeted opt-out rapid HIV screening and physician-directed diagnostic rapid HIV testing from the Denver ED HIV Opt-Out Study.

<p>Abbreviations: N/A = not applicable; ED = emergency department; WB = western blot.</p><p>Includes personnel time for trainers, trainees, and training supplies.</p

Patient flow diagram for the Denver Opt-Out Study.

<p>Eligible patients included those ≥16 years of age who were placed in an emergency department treatment room. (*Screening refers to HIV testing in conjunction with nontargeted opt-out screening, whereas testing refers to HIV testing in conjunction with physician-directed diagnostic testing.)</p

Cost effectiveness ratios (CER) and the incremental cost effectiveness ratio (ICER) of nontargeted opt-out rapid HIV screening and physician-directed diagnostic rapid HIV testing for patients newly diagnosed with HIV infection from the Denver ED HIV Opt-Out Study, Denver, Colorado.

<p>Defined as the number of patients newly-diagnosed with HIV infection.</p