Comparative safety and costs of stepping down asthma medications in patients with controlled asthma

J Allergy Clin Immunol. 2016 May;137(5):1373-1379.e3. doi: 10.1016/j.jaci.2015.08.035. Epub 2015 Oct 21.

Abstract

Background: Limited data exist regarding outcomes after stepping down asthma medication.

Objective: We sought to compare the safety and costs of stepping down asthma controller medications with maintaining current treatment levels in patients with controlled asthma.

Methods: Patients with persistent asthma were identified from the US Medical Expenditure Panel Survey years 2000-2010. Each patient had Medical Expenditure Panel Survey data for 2 years, and measurement was divided into 5 periods of 4 to 5 months each. Eligibility for stepping down asthma controller medications included no hospitalizations or emergency department visits for asthma in periods 1 to 3 and no systemic corticosteroid and 3 or less rescue inhalers dispensed in periods 2 and 3. Steps were defined by type and dose of chronic asthma medication based on current guidelines when comparing period 4 with period 3. The primary outcome of complete asthma control in period 5 was defined as no asthma hospitalizations, emergency department visits, and dispensed systemic corticosteroids and 2 or fewer dispensed rescue inhalers. Multivariable analyses were conducted to assess safety and costs after step down compared with those who maintained the treatment level.

Results: Overall, 29.9% of patients meeting the inclusion criteria (n = 4235) were eligible for step down; 89.4% (95% CI, 86.4% to 92.4%) of those who stepped down had preserved asthma control compared with 83.5% (95% CI, 79.9% to 87.0%) of those who were similarly eligible for step down but maintained their treatment level. The average monthly asthma-related cost savings was $34.02/mo (95% CI, $5.42/mo to $61.24/mo) with step down compared with maintenance of the treatment level.

Conclusion: Stepping down asthma medications in those whose symptoms were controlled led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level.

Keywords: Asthma; anti-inflammatory agents; antiasthma agents; de-escalate; health services; reduce; step down; taper; withdraw.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / economics
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-Agonists / economics
  • Adrenergic beta-Agonists / therapeutic use
  • Adult
  • Aged
  • Anti-Asthmatic Agents / economics*
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy
  • Asthma / economics*
  • Child
  • Child, Preschool
  • Cost Savings
  • Female
  • Humans
  • Leukotriene Antagonists / economics
  • Leukotriene Antagonists / therapeutic use
  • Lipoxygenase Inhibitors / economics
  • Lipoxygenase Inhibitors / therapeutic use
  • Male
  • Middle Aged
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists
  • Anti-Asthmatic Agents
  • Leukotriene Antagonists
  • Lipoxygenase Inhibitors