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CARLOS A. CAMARGO, JR., M.D., DR.P.H., is Director, EMNet Coordinating Center, Massachusetts General Hospital, Boston. SULABHA RAMACHANDRAN, PH.D., is Manager, Health Economics and Outcomes Research, AstraZeneca LP, Wilmington, DE. KIRA L. RYSKINA, B.A., is Consultant, Health Benchmarks, Inc. Woodland Hills, CA. BARBARA EDELMAN LEWIS, PH.D., is Director, Health Economics and Outcomes Research, AstraZeneca LP. ANTONIO P. LEGORRETA, M.D., M.P.H., is Adjunct Professor, Department of Health Services, School of Public Health, University of California, Los Angeles, CA.

Address correspondence to Dr. Camargo at EMNet Coordinating Center, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114 (ccamargo{at}partners.org).

Purpose. To evaluate the effectiveness of budesonide inhalation suspension relative to other common asthma therapies in a high-risk population, a study was conducted to compare the risk of having a repeat asthma-related hospitalization or emergency department (ED) visit in a Medicaid population of children; the relationship between asthma medication adherence level and repeat asthma hospitalizations or ED visits was also evaluated. Methods. Children eight years of age or younger, with a hospitalization or ED visit for asthma between January 1999 and June 2001 (index event), were identified in a Florida Medicaid database. Claims data for each child were examined 12 months before and after the index event. Cox proportional hazards regression was used to model the risk of subsequent asthma exacerbation according to the asthma medication received during the first 30 days after the index event. Logistic regression was used to model the relationship between medication adherence as measured by the medication possession ratio (MPR) and the likelihood of a subsequent asthma exacerbation. Results. There were 10,976 children in the study. Patients who had a claim for budesonide inhalation suspension had a lower risk of a subsequent hospitalization or ED visit (hazard ratio, 0.55; 95% confidence interval, 0.41–0.76; p < 0.001) than patients who did not have budesonide inhalation suspension claims. Other controller medications were not associated with a reduction in the risk of subsequent asthma exacerbations. Adherence to medication was poor (a median MPR of 0.08 for budesonide inhalation suspension and a median MPR of 0.16 for any asthma controller medication). The odds of a repeat hospitalization or ED visit were significantly lower for children who were adherent to their asthma controller medication. Conclusion. Children with asthma and insured by Medicaid were at a high risk of repeat exacerbations leading to increased hospitalizations and ED visits. Treatment with budesonide inhalation suspension in the first 30 days after a hospitalization or ED visit for asthma was associated with a significant reduction in the risk of repeat asthma-related hospitalizations or ED visits during the following year. Children who were adherent to their asthma controller medication had significantly lower odds of having a subsequent asthma exacerbation. Index terms: Aerosols; Asthma; Budesonide; Compliance; Health-benefit programs; Patients; Pediatrics; Steroids, cortico-

 

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