Inhaled corticosteroids (ICS) are widely administered for individuals with chronic obstructive pulmonary disease (COPD) at low risk of exacerbations despite indications of harm. Researchers believe ICS prescriptions to be of “poor value in this demographic.” The relationship between low-value ICS and subsequent healthcare use and expenses is uncertain. Understanding this link could help inform attempts to limit the low-value treatment provided. To see if low-value ICS prescribing is linked to higher outpatient healthcare consumption and expenditures in COPD patients who aren’t at risk of exacerbation. Between January 1, 2010, and December 31, 2018, Researchers conducted a cohort study, identifying a cohort of COPD veterans who underwent pulmonary function tests (PFTs) at 21 Veterans Affairs medical locations across the country. Patients were considered to have a low exacerbation risk if they had fewer than two outpatient exacerbations and no COPD hospitalizations in the year before PFTs. The receipt of an ICS prescription in the three months preceding the date of PFTs was our major exposure. In the year following PFTs, our key objectives were outpatient utilization and outpatient expenses. Researchers used confounder-adjusted negative binomial models for utilization and generalized linear models for expenses to make inferences.
A total of 31,551 COPD patients were recognized as having a low risk of exacerbation. 9,742 of these patients were prescribed low-value ICS (mean [standard deviation (SD)] age, 69 [9] years), while 21,809 were not (mean [SD] age, 68 [9] yr). Patients exposed to low-value ICS had 0.53 more encounters per year (95% confidence interval CI, 0.23–0.83) and spent $154.72 more per patient per year (95% confidence interval CI, $45.58–$263.86) than those who were not. Low-value ICS prescriptions were linked to higher outpatient healthcare utilization and costs in the future. Low-value ICS may be a marker of poor respiratory symptom control, 2) there is confounding by indication, or 3) low-value ICS resulting in increased drug expenditures or utilization, according to potential mechanisms. Health systems should target low-value ICS prescriptions to promote value-based treatment.
Reference:www.atsjournals.org/doi/full/10.1513/AnnalsATS.202009-1128OC
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