Low-value Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease and the Association with Health Care Utilization and Costs

Thesis (Master's)--University of Washington, 2021Rationale: Inhaled corticosteroids (ICS) are not first-line therapy for patients with chronic obstructive pulmonary disease (COPD) at low risk of exacerbation, but are commonly prescribed despite evidence of harm. We consider ICS prescription in this population “low-value.” The association of low-value ICS with subsequent health care utilization and costs is unknown. Understanding this relationship could inform efforts to reduce the delivery of low-value care. Objective: To determine whether low-value ICS prescribing is associated with higher outpatient health care utilization and costs among patients with COPD who are at low risk of exacerbation. Methods: We performed a cohort study between January 1, 2010 and December 31, 2018, identifying a cohort of Veterans with COPD who performed pulmonary function tests (PFTs) at 21 Veterans Affairs Medical Centers nationwide. Patients were defined as having low exacerbation risk if they experienced