Stepping up the controller medication in asthma patients: Impact of various treatment options on costs
Bibliographic record
Abstract
Introduction: To compare asthma-related costs among adults who step-up their controller medication. Methods: A population-based study was conducted using the administrative health data of British Columbia, Canada (1997 to 2007). Hospitalization, physician visits, and prescription records were used to identify asthma patients (age 14-65) and calculate direct costs. Four cohorts were constructed as those who: increased the dose of inhaled corticosteroids (ICS+ group), switched to ICS/long-acting beta-agonist (LABA) in a single formulation (ICS/LABA group), added LABA in separate formulations (ICS+LABA group), or added leukotriene receptor antagonist (ICS+LRA group). The outcome was the direct cost of asthma (2008 CAD) in the year after the step-up, adjusted for multiple demographic, resource use, and comorbidty variables from the previous year. Results: 32,640 patients (average age 42.3; 60.3% female) were included (7,115 ICS+, 19,457 ICS/LABA, 4,086 ICS+LABA, and 1,982 ICS/LRA). The average costs of asthma for the year after the index date for the ICS+ group was $509. Compared to ICS+, all other groups had significantly positive incremental costs: +$358.0 for ICS/LABA, +$504.3 for ICS+LABA, and +$541.6 for ICS/LRA (all P-values<0.01). Higher age, higher resource use, and higher cumulative dose of rescue medication in the year prior to the step-up date were predictors of higher costs after the step-up date (all p<0.01). Conclusions: Based on relatively large sample and adjusted for several potential confounders, increasing ICS dose as a step-up approach was associated with the lower costs compared to addition of a second class of controller medication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".