Cost Reduction With Inhaled Corticosteroid Prescribing Guide in Children Admitted for Severe Acute Asthma

Introduction: Pediatric patients with severe acute asthma (SAA) were commonly prescribed home asthma controller medications at our institution upon admission to support adherence resulting in concomitant prescribing of both systemic (SCS) and inhaled corticosteroids (ICS). However, the benefit of this practice and pharmacokinetic principles do not support it. A prescribing guide was implemented to limit ICS prescribing for SAA pediatric patients receiving SCS to reduce cost.

Objectives: To compare ICS cost in the pre- to post-guide implementation cohort in pediatric patients admitted for SAA.

Study Design: Retrospective chart review of children admitted for SAA in the month of September 2013 (pre-guide cohort A) and September 2014 (post-guide cohort B).

Methods: Patients that received SCS during the study time period were screened for inclusion based on following criteria: age 6 months - 14 years old, home ICS use prior to admission, and SAA admission diagnosis. Primary endpoint was total cost of ICS dispensed. Secondary endpoints were ICS cost per patient and readmission rate. Statistical analysis included Fisher exact and Mann-Whitney U.

Results: Forty-one patients were included: 16 in cohort A and 25 in B. No difference in baseline demographics was detected including age, gender, and asthma classification prior to admission.  High dose ICS use at home was more common in cohort B (31% vs. 4%, p = 0.023). All patients in cohort A were prescribed ICS compared to 3 patients (12%) in cohort B (p < 0.001). Total institutional ICS cost for cohort A and B was $3122 and $681, respectively, and mean cost per patient was $195 ± 77 compared to $27 ± 86 for cohort A and B, respectively (p < 0.001). No patients were readmitted within 30 days.

Conclusions: Implementation of a prescribing guide significantly reduced the incidence of ICS prescribing and cost to the institution.