Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Volume 9, Issue 11, Pages 3969-3976Publisher
ELSEVIER
DOI: 10.1016/j.jaip.2021.01.039
Keywords
Asthma; Monoclonal antibody; Omalizumab; Mepolizumab; Benralizumab; Reslizumab; Dupilumab; IQVIA's National Disease and Therapeutic Index; NDTI; Pharmacoepidemiology; Drug utilization; National Ambulatory Medical Care Survey; NAMCS
Categories
Funding
- Johns Hopkins University Provost's Postdoctoral Fellowship Award
- NIH/NIMHD K99/R00 MOSAIC [K99MD015767-01]
- National Institute of Allergy and Infectious Diseases
- National Institute of Environmental Health Sciences
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Despite bearing a disproportionate burden of poorly controlled asthma, publicly insured individuals are less likely to receive biologics, according to data from IQVIA in the United States. The lower use of biologics among publicly insured individuals, where the burden of uncontrolled asthma is greatest, requires further investigation.
BACKGROUND: Despite bearing a disproportionate burden of poorly controlled asthma, publicly insured individuals are less likely to receive biologics. OBJECTIVE: To assess biologic use by payer among individuals with asthma. METHODS: We used IQVIA's National Disease and Therapeutic Index, a nationally representative, all-payer audit of ambulatory care in the United States, to describe the patterns of use by payer. RESULTS: Asthma treatment visits in which a biologic product was reported increased from approximately 0.1% of asthma-related visits in 2003 to 1% in 2015 and doubled to 2% by 2019. Omalizumab use initially increased from 2003 to 2006 and plateaued till 2015 when its use declined modestly, coinciding with the release of additional biologic products. In 2019, omalizumab accounted for 37% of biologic treatment visits, mepolizumab 21%, benralizumab 27%, dupilumab 15%, and reslizumab <1%. Biologic treatment visits were higher for privately insured individuals (28.3 per 1000 visits) compared with publicly insured individuals (16.3 per 1000 visits). This difference persisted after accounting for age, sex, and race using nationally representative estimates. White patients accounted for a disproportionate amount of biologic treatment visits among the publicly insured (80%) despite accounting for only 60% of publicly insured asthma treatment visits. No biologic treatment visits were observed for individuals who were uninsured. Half of dupilumab visits were for publicly insured patients, compared with 22% of mepolizumab/benralizumab and 27% of omalizumab visits. CONCLUSION: Biologics were uncommonly used among patients with asthma, and the basis for disproportionately lower use of biologics among the publicly insured, where the burden of uncontrolled asthma is greatest, merits further investigation. (C) 2021 American Academy of Allergy, Asthma & Immunology.
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