Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. Issue 2 (20th November 2018)

• Record Type: Journal Article
• Authors: Voorham, Jaco; Xu, Xiao; Price, David B.; Golam, Sarowar; Davis, Jill; Zhi Jie Ling, Joanna; Kerkhof, Marjan; Ow, Mandy; Tran, Trung N.
• Is Part Of: Allergy. Volume 74:Issue 2(2019)
• Page Start: 273
• Page End: 283
• Publication Date: 2018-11-20
• Subjects: adverse outcomes -- asthma -- healthcare costs -- healthcare resource utilization -- systemic corticosteroids; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.13556
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: Although systemic corticosteroid (SCS) treatment, irrespective of duration or dosage, is associated with adverse outcomes for patients with asthma, the longitudinal effects of this treatment on adverse outcomes, healthcare resource utilization (HCRU), and healthcare costs are unknown. Methods: We identified patients initiating intermittent or long‐term SCS who were diagnosed with active asthma from UK general practice with linked secondary care data. Control (non‐SCS) patients were matched by sex and index date with those initiating SCS. Minimum baseline period was 1 year prior to index date; minimum follow‐up duration was 2 years post–index date. Cumulative incidence of SCS‐associated adverse outcomes and associated HCRU and costs were compared between SCS and non‐SCS patient groups and among average SCS daily exposure categories. Associations between exposure and annualized HCRU and costs were assessed, adjusted for confounders. Results: Analyses included 9413 matched pairs. Median (interquartile range) follow up was as follows: SCS group: 7.1 (4.1‐11.8) years; control group: 6.4 (3.8‐10.0) years. Greater SCS dosages were correlated with greater cumulative incidence. For example, patients with type 2 diabetes receiving an average daily dosage of ≥7.5 mg had a 15‐year cumulative incidence (37.5%) that was 1.5‐5 times greater than those receiving lower dosages. HCRU and costs increased annually for SCS patients but not for non‐SCS patients. Increases in all‐cause adverse outcome (excluding asthma)–associated HCRU and costs were dose‐dependent. Conclusions: Over the long term, adverse outcomes associated with SCS initiation were relatively frequent and costly, with a positive dosage–response relationship with SCS exposure. Abstract : A greater cumulative incidence of adverse outcomes is correlated with greater systemic corticosteroid dosage for patients with asthma. Patients with asthma receiving systemic corticosteroids experience increases in annual health care resource utilization and costs, while those not receiving systemic corticosteroids do not. A dose‐dependent increase in all‐cause adverse outcome (excluding asthma)–associated annual health care resource utilization and costs occurs for patients with asthma receiving systemic corticosteroids.