Cross-sectional assessment of persistency with inhaled corticosteroids (ICS) in pediatric asthmatic patients aged 8 years or younger

Abstract Rationale NHLBI guidelines recommend the use of ICS (alone or in combination with other agents) as maintenance therapy for all severities of persistent asthma. Lack of persistency with ICS use can contribute to higher asthma costs, especially in pediatric patients. We examined claims records of children with asthma to assess persistency with ICS therapy. Methods Children aged 8 years or younger with an asthma diagnosis and pharmacy claim for an ICS were identified using a 6-month identification period (7/1/00-12/31/00) from an employer health care claims database comprising over 3.6 million patients. Pharmacy claims in the 360 days after the index prescription were examined for the presence of ICS claims to measure persistency. Persistency was calculated using medication possession ratio and number of quarters with 1 or more ICS claim. Results 3,334 patients were identified in the 6-month identification period. Medication possession ratio was 0.279 for the 360 days following the initial index ICS claim. Analysis of quarterly ICS use following the index date revealed that 1,180 patients (35.4%) had 1 quarter with an ICS fill, 821 (24.6%) had 2 quarters with an ICS fill, 675 (20.2%) had 3 quarters with an ICS fill, and 658 (19.7%) had an ICS fill in all 4 quarters. Excluding the 939 patients with no ICS refills resulted in a medication possession ratio of 0.358. Conclusions Results of this research highlight the inadequate use of ICS in pediatric patients with asthma, suggesting that national guidelines recommending persistent ICS use for optimal asthma control are not being followed.