Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids - a Swedish observational cohort study (PACEHR)

• Published in: Respiratory research Vol. 19; no. 1; pp. 168 - 8
• Main Authors: Janson, Christer, Lisspers, Karin, Ställberg, Björn, Johansson, Gunnar, Telg, Gunilla, Thuresson, Marcus, Nordahl Christensen, Helene, Larsson, Kjell
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.09.2018; BioMed Central; BMC
• Subjects: Administration, Oral; Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Analysis; Asthma; Asthma - economics; Asthma - epidemiology; Asthma - therapy; Cohort analysis; Cohort Studies; Corticoids; Corticosteroid drugs; Corticosteroids; Cost; Costs; Dosage and administration; Drug dosages; Drug therapy; Economic aspects; Female; Follow-Up Studies; Health care; Health care costs; Health Care Costs - trends; Health care expenditures; Health care resource utilization; Health services; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Klinisk medicin; Leukocytes (eosinophilic); Lung diseases; Lungmedicin och allergi; Male; Medical care utilization; Medical records; Medicin och hälsovetenskap; Middle Aged; Morbidity; Observational studies; Obstructive lung disease; Oral corticosteroids; Patient Acceptance of Health Care; Patients; Population; Primary care; Resource utilization; Respiratory function; Severe asthma; Studies; Sweden - epidemiology; Treatment Outcome; Uncontrolled asthma; Sweden; United Kingdom > UK; Oral corticosteroids; Severe asthma; Cost; Uncontrolled asthma; Health care resource utilization
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-018-0855-3

Patients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients. Primary care medical records data were linked to data from Swedish national health registries. Patients ≥18 years with a drug claim for obstructive pulmonary diseases during 2007-2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months' post index period: regular OCS equals ≥5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated. A total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10-12% of the total cost in all three groups. In this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.