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. 2018 Feb;73(2):116-124.
doi: 10.1136/thoraxjnl-2017-210531. Epub 2017 Sep 16.

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Marjan Kerkhof  1 , Trung N Tran  2 , Joan B Soriano  3 , Sarowar Golam  4 , Danny Gibson  5 , Elizabeth V Hillyer  1 , David B Price  1   6
Affiliations

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Marjan Kerkhof et al. Thorax. 2018 Feb.

Abstract

Background: Little is known about the prevalence of severe, uncontrolled eosinophilic asthma (SUEA) and associated costs.

Aims: We sought to determine the prevalence of SUEA and compare asthma-related healthcare resource use (HCRU) and associated costs with overall means for a general asthma population.

Methods: This cohort study evaluated anonymised medical record data (December 1989 through June 2015) from the Clinical Practice Research Datalink and the Optimum Patient Care Research Database to study UK patients with active asthma (diagnostic code and one or more drug prescriptions in the baseline year), aged 5 years and older, without concomitant COPD, and with recorded eosinophil count. SUEA was defined as two or more asthma attacks during 1 baseline year preceding a high blood eosinophil count (≥0.3×109/L) for patients prescribed long-acting β2-agonist (LABA) and high-dosage inhaled corticosteroids (ICS) during baseline plus 1 follow-up year. We compared asthma-related HCRU and associated direct costs (2015 pounds sterling, £) during the follow-up year for SUEA versus the general asthma population.

Results: Of 363 558 patients with active asthma and recorded eosinophil count, 64% were women, mean (SD) age was 49 (21) years; 43% had high eosinophil counts, 7% had two or more attacks in the baseline year and 10% were prescribed high-dosage ICS/LABA for 2 study years. Overall, 2940 (0.81%; 95% CI 0.78% to 0.84%) patients had SUEA. Total mean per-patient HCRU and associated costs were four times greater for SUEA versus all patients (HCRU and cost ratios 3.9; 95% CI 3.7 to 4.1).

Conclusions: Less than 1% of patients in a general asthma population had SUEA. These patients accounted for substantially greater asthma-related HCRU and costs than average patients with asthma.

Keywords: asthma; attacks; costs; eosinophils; exacerbations; observational study; severe uncontrolled asthma.

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Conflict of interest statement

Competing interests: MK is an employee of the Observational and Pragmatic Research Institute Pte Ltd (OPRI), which conducted this study with funding from AstraZeneca and which has conducted paid research in respiratory disease on behalf of the following other organizations: Aerocrine, AKL Research and Development Ltd, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, Theravance, UK National Health Service and Zentiva. TNT, SG and DG are employees of AstraZeneca. JBS is a consultant to OPRI and has received pharmaceutical company grants from GSK in 2011 and Chiesi in 2012 via CIMERA his former home institution, and in 2014 and 2015 from Linde via Hospital Universitario de La Princesa; JBS participated in speaking activities, advisory committees and consultancies during the period 2011-2016 sponsored by: Almirall, AstraZeneca, Boehringer-Ingelheim, Chiesi, ERS, GEBRO, Grifols, GSK, Linde, Lipopharma, Mundipharma, Novartis, Pfizer, RiRL, Rovi, SEPAR, Takeda and Teva. EVH is a consultant to OPRI and has received fees for medical writing assistance from Merck. DBP has board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Mundipharma, Napp, Novartis and Teva Pharmaceuticals; consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, TevaPharmaceuticals, Theravance, UK National Health Service, Zentiva; payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, and Teva Pharmaceuticals; payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma and Novartis; payment for travel/accommodation/meeting expenses from Aerocrine, AstraZeneca, Boehringer Ingelheim, Mundipharma, Napp, Novartis and Teva Pharmaceuticals; funding for patient enrolment or completion of research from Chiesi, Novartis, Teva Pharmaceuticals and Zentiva; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia, Singapore, and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); and is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme and Health Technology Assessment.

Figures

Figure 1
Figure 1
Patient flow chart. *Active asthma was defined as one or more prescriptions for asthma medication in the baseline year and asthma not resolved. †Includes those aged ≥40 years with concomitant COPD diagnosis. COPD, chronic obstructive pulmonary disease; CPRD, Clinical Practice Research Datalink; OPCRD, Optimum Patient Care Research Database.
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