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Inappropriate Overuse of Inhaled Corticosteroids for COPD Patients: Impact on Health Costs and Health Status

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Abstract

The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: €1,590 (SD = 1,834) vs. €1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36–5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02–1.97)], depression [OR: 1.47 (95% CI: 1.05–2.05)], any allergy [OR 1.69 (95% CI: 1.13–2.54)], and physical health status [OR 0.97 (95% CI: 0.96–0.98)]. Lack of adherence to the recommended criteria for using inhaled corticosteroids therapy in the management of COPD patients was associated with lower self-reported health status and higher costs. Factors statistically associated with inappropriate use of corticosteroids were educational attainment, a history of heart disease, depression, any allergy, and physical health status.

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Authors and Affiliations

  1. Pneumology Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain

    Javier de Miguel-Díez

  2. School of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Pilar Carrasco-Garrido, Valentín Hernandez-Barrera, Angel Gil de Miguel & Rodrigo Jimenez-Garcia

  3. Department of Health Outcomes Research, Medical Unit, Pfizer España, Alcobendas, Madrid, Spain

    Javier Rejas-Gutierrez

  4. Medical Unit, Pfizer España, Alcobendas, Madrid, Spain

    Antonio Martín-Centeno

  5. Medical Department, Boehringer Ingelheim España, San Cugat del Vallés, Barcelona, Spain

    Elena Gobartt-Vázquez

Authors
  1. Javier de Miguel-Díez
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  2. Pilar Carrasco-Garrido
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  3. Javier Rejas-Gutierrez
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  4. Antonio Martín-Centeno
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  5. Elena Gobartt-Vázquez
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  6. Valentín Hernandez-Barrera
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  7. Angel Gil de Miguel
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  8. Rodrigo Jimenez-Garcia
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Correspondence to Javier de Miguel-Díez.

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de Miguel-Díez, J., Carrasco-Garrido, P., Rejas-Gutierrez, J. et al. Inappropriate Overuse of Inhaled Corticosteroids for COPD Patients: Impact on Health Costs and Health Status. Lung 189, 199–206 (2011). https://doi.org/10.1007/s00408-011-9289-0

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  • DOI: https://doi.org/10.1007/s00408-011-9289-0

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