PAR19: IMPACT OF THE ADDITION OF SALMETEROL TO THE TREATMENT OF ASTHMA PATIENTS IN A MEDICAID FEE-FOR-SERVICE POPULATION

Abstract

OBJECTIVE: Salmeterol, a long acting beta-2 agonist, improves lung function and symptom control with twice daily dosing in moderate-to-severe asthmatics. This investigation was performed to determine whether the introduction of salmeterol to moderate-to-severe asthmatics in a Medicaid fee-for-service population reduces the overall asthma related health care expenditures. METHODS: The New Mexico Medicaid fee-for-service claims database was searched between 1/1/94 and 12/31/98 to identify both a salmeterol and control group. The inclusion criteria for the salmeterol group were: patients receiving salmeterol, who were 66% compliant with salmeterol therapy, had a diagnosis of asthma (ICD-9: 493.0, 493.1, 493.9), were 13 years of age or older, did not have a diagnosis of COPD (ICD-9: 496.x) and must have been Medicaid eligible for 2 consecutive years. In addition to the above criteria for the salmeterol group, to be included in the control group, patients must not have received salmeterol between 4/12/95 and 4/12/97 (around the median start date of salmeterol, 4/12/96), and in order to match for severity must have received other asthma maintenance medications. Patients meeting these criteria for the salmeterol and control groups were 57 and 58, respectively. ANCOVA were performed to compare costs between the two groups controlling for baseline costs. Average per patient benefit-cost ratios were calculated by dividing total cost savings by increase in medication costs for both groups. RESULTS: No significant difference existed among average per patient total health care expenditures between the salmeterol and control groups ($2266 and $1955, respectively). Interestingly, in the salmeterol group, total medication costs increased significantly (t = ?7.895, p = 0.000) while total health care costs decreased, although not significantly. The average per patient benefit-cost ratio for the salmeterol group was 0.061 ($41/$668). CONCLUSION: Introduction of salmeterol in the New Mexico Medicaid fee-for-service population did not significantly reduce total asthma related health care costs.