Changes in Expenditures for Asthma Medications in Adults

The prevalence of asthma has increased across all age groups over the past 10 years. Asthma is a chronic inflammatory disorder of the airways and adverse health outcomes can result when it is poorly controlled. Guidelines for the management of asthma in the updated pharmacology section of recommendations from the National Asthma Education and Prevention Program call for a stepwise approach to long-term asthma management to achieve and maintain asthma control.

The guidelines recommend 3 general types of asthma medications: (1) controllers, (2) relievers, and (3) oral corticosteroids (OCSs). Inhaled corticosteroids (ICSs), a type of controller, are recommended as first-line therapy for patients with persistent asthma. ICSs treat asthma symptoms by minimizing inflammation and reducing the risk of serious exacerbations. For patients with intermittent asthma, the guidelines recommend the use of relievers to treat moderate or serious asthma attacks by relaxing airway muscles. For patients with severe asthma symptoms that do not respond to other medications, the guidelines call for the use of OCSs.

The Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) Statistical Brief #374, released in July, focused on changes in asthma medication use and expenditures in the United States over 10 years. The brief is titled Changes in Adult Asthma Medication Use and Expenditures, United States, 1998-1999 to 2008-2009.

The brief utilized data on adults ≥18 years of age with reported treatment for asthma from the Household Component and Medical Provider Component of the MEPS. All differences in the brief were statistically significant at the .05 level or better.

Over the period of the survey, the annual proportion of adults with asthma using controllers increased from 54.3% to 59.9%; in the same time period, the average annual proportion of those using relievers fell from 67.7% to 61.7%. In 2008 to 2009, an estimated 12.4% of adults used oral corticosteroids.

There was an increase in the use of 2 classes of medications to manage asthma over the study period: (1) the average annual proportion of patients using inhaled corticosteroids increased from 39.9% to 51.2%, and (2) the average annual proportion of patients using leukotriene receptor antagonists increased from 12.4% to 20.4%.

The average annual healthcare expenditures for adults with reported treatment for asthma increased from $27.8 billion to $104.6 billion, over the study period. The average annual total out-of-pocket expenditures grew from $4.5 billion to $14.3 billion over the same time period.

Similar increases in expenditures occurred in costs of prescribed asthma medications; average total expenditures increased from $2.5 billion to $10.2 billion. Average total expenditures for controllers increased more than 4-fold from $1.7 billion to $7.8 billion and average annual total expenditures for relievers tripled from $793 million to $2.4 billion.

The average annual expenditures per user for all prescribed asthma medications increased from $553 to $1126 over the study period; average annual expenditures per user for controllers more than doubled, from $569 to $1258, and average annual expenditures per user for relievers increased from $212 to $373 (an increase of 76.1%).

Out-of-pocket expenditures per user on all prescribed asthma medications by adults with reported treatment for asthma were $227 in 1998 to 1999 and $235 in 2008 to 2009. In 2008 to 2009, out-of-pocket expenditures per user averaged $239 for controllers and $99 for relievers.

During the study period, average annual expenditures per user for OCS decreased from $39 to $17 (a decrease of 56.4%). Average out-of-pocket expenditures per user on OCS decreased 56.5%, from $23 to $10.

In 2008 to 2009, average annual out-of-pocket expenditures per user for controllers were more than twice the annual average out-of-pocket expenditures per user for relievers and >22 times the annual average out-of-pocket expenditures per user for OCS.