Methods: We performed a cross-sectional retrospective study using commercial insurance claims from 2013. Moderate-to-severe persistent asthma patients were those with ≥2 asthma claims, ≥2 asthma medications, EPR3 Step 4-6, and either high-OCS (≥1 fill ≥30 days, or ≥6 bursts of OCS, based on previous study) or low-OCS (no fills ≥30 days and <2 OCS bursts) use. We excluded patients with COPD claims. We described demographics, comorbidities, medication use, healthcare utilization and costs. ANCOVA and Logistic regression models were used to adjust for between-group differences.
Results: 2,320 patients met the inclusion criteria 217 high- and 2,103 low-OCS users. High- and low-OCS users were similar in age (56.8 years [SD 14.7] and 54.6 years [SD 16.2]) and gender distribution (71.4% and 64.9% female). High-OCS users had more chronic and respiratory-related conditions and were more likely Step 5/6. High-OCS users had higher odds of hospitalization (all-cause OR 1.81, 95% CI 1.25-2.62; asthma-related OR 4.95, 95% CI 1.98-12.40). High-OCS users also had higher costs (all-cause $17,122 [SE $2,395; p<0.001]; asthma-related $3,728 [SE $387; p<0.01] difference high vs. low OCS).
Conclusions: After adjusting for demographics, clinical characteristics and disease severity, patients with OCS fills ≥30 days have higher healthcare resource use and cost than low-OCS users. High OCS exposure may be a marker for poor asthma control and resultant increase in resource use/costs.