Over the past few months, the US Health and Human Service Department’s Agency for Healthcare Research and Quality (AHRQ) has issued several statistical briefs and a research finding regarding rising expenditures for asthma medications used to treat children in the US. The researchers from AHRQ examined data from the 1997–2008 Medical Expenditure Panel Survey (MEPS) to determine trends in the use of asthma medications by children and in expenditures for those medications (calculated in constant 2008 dollars). The results, says one of the authors, came as no surprise: between 1997 and 2008, expenditures on these medications have skyrocketed.
Over the time period studied, overall expenditures on asthma medications for children quadrupled, from $527 million in 1997-98 to $2.5 billion in 2008, while the percentage of US children treated for asthma rose from 4.7% to 6.1%, meaning that the increase in the percentage of children treated is insufficient to account for the increase in expenditures. While the majority of the expense is borne by insurers and other payers, average annual out-of-pocket expenditures for families of children with asthma also doubled over this time period, rising to $123 per year by 2008.
Approximately 90% of the increase in overall expenditures, the researchers found, is attributable to a sevenfold increase in money spent on controller medications, mostly inhaled corticosteroids (ICS), which accounted for $2.1 billion annually by the end of the period. As the authors regarded oral corticosteroids as a last resort medication, they excluded them from the controller category and examined trends in oral corticosteroid use separately. The prevalence of controller medication use rose from just under 30% in 1997-98 to almost 60% in 2007-08, with much lower increases among minority and lower income children.
While the percentage of children using ICS to control asthma increased threefold over the period studied, from about 15% to about 45%, the use of leukotriene receptor antagonists (LTRAs) grew even faster, from use by less than 3% of treated children in 97-98 to use by more than a third of the children treated for asthma by 05-06. Although the authors don’t take note of it, the FDA approved 4 mg tablets of Merck’s Singulair montelukast for the treatment of asthma in children ages 2-5 in March 2000, and the data show a large increase in LTRA use from 1999-2000 to 2001-02.
The authors of the research findings consider the large increase in the use of controller medications an “encouraging trend.” However, Nancy Sander, President and Founder of Allergy & Asthma Network/Mothers of Asthmatics (AANMA), is “a little surprised” that the increase in expenditures is so large and fears that prevalence of ICS usage actually results in part from a failure to follow the 2007 National Asthma Education and Prevention Program (NAEPP) guidelines correctly, as clinicians automatically prescribe controller medications without properly evaluating the child’s condition.
