Analysis of the effectiveness and cost benefit of leukotriene modifiers in adults with asthma in the Ohio medicaid population

OBJECTIVE: The objectives of this research were to (1) determine the association of the use of leukotriene modifiers (LMs) with 3 clinical outcome measures that can serve as proxy measures of effectiveness: subsequent emergency room visits, hospitalizations, and steroid bursts, and (2) estimate whether LM use compared with nonuse is cost beneficial from a Medicaid payer perspective. METHODS: This was a retrospective, longitudinal study of asthma patients in the fee-for-service Ohio Medicaid program. The study population included 5,541 adult patients who were identified as having a claim containing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for asthma (code 493.xx, excluding 493.2x) in 2001. Logistic regression, controlling for selection bias through the use of propensity scores, was used to determine the association of LM use on 3 outcome measures: emergency room visits, hospitalizations, and steroid bursts. An oral steroid burst was defined as a pharmacy claim for oral prednisone in the date range from 1 day before to 3 days after an office visit that has an ICD-9-CM code for asthma. A cost-benefit analysis was also performed. RESULTS: During the prestudy period, the LM users had higher total medical costs of $72.06 per patient per month (PPPM, $170.60 vs. $98.54, P < 0.001). During the outcome period, there was no significant association between LM use and emergency room visits (odds ratio [OR] 1.09; 95% confidence interval [CI], 0.84-1.38), hospitalizations (OR 1.02; 95% CI, 0.66-1.59), or steroid bursts (OR 1.30; 95% CI, 0.89-1.90). Because LM use was not more effective than nonuse and is more expensive than nonuse, a situation of dominance prevails. The mean cost difference in the 3 primary outcome measures between LM users and nonusers was $1.63 PPPM ($34.93 vs. $33.30, P=0.019). CONCLUSION: In this study of adult Medicaid asthma patients, users of LMs did not have greater asthma control as measured by emergency room visits, hospitalizations, or steroid bursts. In this cohort of adult asthma patients with at least 1 asthma medication, there does not appear to be any cost offsets to the Ohio Medicaid program associated with the use of LMs. The use of LMs was associated with higher total costs for asthma care.