Date of Graduation
School of Pharmacy
Pharmaceutical Systems and Policy
Traci J. LeMasters
S. Suresh Madhavan
In many older adults, asthma and chronic obstructive pulmonary disease (COPD) coexist as “Asthma-COPD overlap” (ACO). This dissertation pursued three Aims: 1) estimate the economic burden of ACO and its contributory factors; 2) evaluate the association of ACO to “cost-related medication nonadherence” (CRN); and 3) identify adherence trajectory patterns and examine the impact of initial maintenance therapies (IMT) type (inhaled corticosteroids monotherapy (ICS) vs. fixed-dose combination of ICS and long-acting beta agonist (ICS/LABA)) on adherence trajectory patterns among older adults Medicare Beneficiaries. The first and second Aims were cross-sectional studies by using Medicare Current Beneficiary Survey data. For the third Aim, we used a longitudinal retrospective cohort design, using 10% sample of Optum’s Deidentified Clinformatics®. In this study, older adults with ACO had nearly four times higher average total healthcare expenditures compared to those no-asthma no-COPD (NANC). The higher number of medications and fragmented care were the leading contributors of the economic burden. Moreover, compared to older adults with NANC, those with ACO were more likely to report any CRN. This association was highly dependent on number of medications. In addition, we identified four medication adherence trajectories to IMT among older adults with ACO. Those who using ICS/LABA were less likely to have “persistent low adherence” (Adjusted Odds Ratio= 0.38). In summary, these findings highlight the need to reduce the economic burden and improve medication adherence among older adults with ACO. Additionally, using ICS/LABA for IMT may improve adherence to IMT among older adults with ACO.
Nili, Mona, "Asthma-COPD Overlap: Economic Burden and Medication Adherence" (2020). Graduate Theses, Dissertations, and Problem Reports. 7680.