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Objective: The authors hypothesized that adherence to anti-inflammatory treatment could reduce overall cost of asthma care, as higher spending on drugs would be offset by reductions in hospital and emergency care., Methods: A retrospective observational study using 2 years of claims data for 41,234 commercially insured asthmatics on monotherapy with either leukotriene inhibitors (LI) or inhaled corticosteriods (ICS). Patients were grouped into adherence quartiles based on the percentage of days per year they had prescriptions filled (medication possession ratio). The relationship between adherence and four outcomes was examined: ( 1 ) emergency department (ED) visits, ( 2 ) hospitalizations, ( 3 ) nondrug net payments for asthma care, ( 4 ) total net payments for asthma care (including drug costs). Multivariate and logistic regression models adjusting for demographics, comorbidities, and measures of past asthma utilization were used., Results: Adherence rates were low with a median medication possession ratio of 39% for LI and 15% for ICS. Both ED and hospital use was negatively associated with adherence to LI. Patients in the lowest quartile experienced 80 (95% confidence interval (CI) = 62-102) ED visits and 34 (95% CI = 22-52) admissions per 1000 patient-years compared to 36 (95% CI = 27-49) ED visits and 13 (95% CI = 8-22) admissions in the highest quartile. In contrast, ED visits and hospital admissions did not differ significantly between adherence groups for ICS. Total payments for asthma care increased significantly with higher adherence for both LI and ICS patients. Comparing the lowest and highest adherence quartile, payments per person per month increased significantly from $65.11 (95% CI = $57.02-$73.20) to $147.46 (95% CI = $139.48-$155.44) for patients on LI and from $38.71 (95% CI = $29.52-$47.90) to 93.13 (95% CI = $83.70-$102.56) for patients on ICS. The only subgroup, for which overall asthma payments did not increase with better adherence, were patients with past ED visit or hospital admission on LI., Conclusions: In this observational study, treatment with LI, but not with ICS, appears to improve disease control, as evidenced by the reduction in the incidence of ED visits and hospitalizations in patients on LI. Savings generated by this reduction in high-cost events don't offset the increased payments for drugs in more adherence patients, except for selected high-risk patients.

We conducted a review of 164 relevant publications to consolidate the evidence on gaps in the quality of asthma care, the impact of those gaps, and the costs and benefits of closing those gaps. Researchers used a wide variety of definitions for measures of quality asthma care, clinical and utilization end points, and disease severity. Gaps in care were most evident for pharmacologic treatment, particularly the underuse of inhaled corticosteroids, with median usage rates of 40%; however, in studies with large proportions of black subjects, the inhaled corticosteroid usage rate was only 32%, compared with 51% for nonminority populations. Studies on outcomes focused on emergency department visits, hospital admissions, and missed school days. Because only 6 studies included information on the costs of improving asthma care, no consensus estimates of the cost/benefit ratio for better asthma care could be derived. There was insufficient evidence in the literature for assessment of the impact of gaps in care and the costs of closing those gaps. More economic evaluations of the impact of gaps in asthma care and of interventions to improve asthma control are needed. Future research on gaps in asthma care and their impact must use standardized definitions for key variables such as disease severity and care utilization to allow comparisons across studies and building of an evidence base that is convincing for policy makers and purchasers of care.

Conventional superelastic orthodontic wires are arch-shaped, have the same mechanical properties all along their length and are used to correct the position of teeth. The disadvantage of these archwires is that there are different types of teeth in the mouth and different forces are therefore needed to rectify their position. The aim of this work was to laser weld several types of NiTi orthodontic wires that had different chemical compositions and superelastic properties, in order to adjust their properties to different parts of the mouth. Microstructural changes, transformation stresses and temperatures, variations in corrosion behaviour and ion release were studied in the welded wires.