A COMPARATIVE EFFECTIVENESS EXAMINATION OF ASTHMA TREATMENTS IN THE MARYLAND MEDICAID POPULATION: THREE ESSAYS
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DepartmentSchool of Public Policy
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This is a three-paper dissertations on the comparative effectiveness for asthma treatments. While it has been repeatedly demonstrated that inhaled corticosteroids (ICS) are more clinically efficacious than leukotriene receptor antagonists (LTRA) for the treatment of persistent asthma, it has also been established that adherence to ICS treatment is low yet LTRA adherence is high. This dissertations investigates whether a lower efficacious/high adherence treatment is as effective as a highly efficacious/low adherence treatment for the treatment of mild to moderate persistent asthma. The first paper (Comparison of Leukotriene Receptor Antagonists and Inhaled Corticosteroids for the Treatment of Asthma: A Systematic Literature Review) systematically reviews the current literature to assess two aspects of the comparative effectiveness asthma research of LTRA and ICS monotherapy. First, the paper addresses whether the literature identifies similar outcomes for the two treatments as evidenced by emergency department (ED) visits and inpatient hospitalizations. Second, the method of grading the quality of the evidence is also examined. The second paper evaluates the generalizability of previous research findings by conducting a comparative-effectiveness study of ICS and LTRA in the Maryland Medicaid population. The third paper examines whether medication adherence for LTRA and ICS affects the comparative-effectiveness of the treatments for the Maryland Medicaid population. Keywords: leukotriene receptor antagonist, inhaled corticosteroid, comparative-effectiveness