Incidence and Treatment Cost of Oral Candidiasis Among Users of Inhaled Bronchial Steroids

• Objective: To determine the incidence and treatment cost of oral candidiasis among patients using triamcinolone acetonide (TAA) as their only inhaled bronchial steroid (IBS) and patients using other IBS agents. • Design: A retrospective analysis was conducted using a pharmacy benefits management claims database. • Patients: Patients between 6 and 80 years of age were included in the study if they filled prescriptions for IBS products between 1 July 1998 and 30 June 1999, had continuous insurance eligibility during the study period, and had not filled a prescription for sulfamethoxazole/trimethoprim during the study period. 186,961 patients were included: 57,321 in the TAA cohort and 129,640 in the other IBS cohort. • Outcome measures: Number of IBS prescriptions filled, number of IBS canisters obtained, length of IBS therapy, drug exposure, total cost of IBS therapy, antifungal use, and cost of antifungal therapy. • Results: The odds of concomitant oral antifungal therapy were significantly lower in the TAA cohort compared with the other IBS cohort (OR, 1.43; 95% confidence interval, 1.33 to 1.53; P = 0.001). The mean perpatient-per-year cost of concomitant oral antifungal therapy was significantly lower for the TAA cohort (Wilcoxon Z = –4.53, P = 0.001). • Conclusion: Patients using TAA as their only IBS had a significantly lower incidence of concomitant antifungal therapy use and lower cost of concomitant antifungal therapy compared with patients using other IBS products.