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Observational Study
. 2018 Sep 3;19(1):168.
doi: 10.1186/s12931-018-0855-3.

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

Christer Janson  1 , Karin Lisspers  2 , Björn Ställberg  2 , Gunnar Johansson  2 , Gunilla Telg  3 , Marcus Thuresson  4 , Helene Nordahl Christensen  3 , Kjell Larsson  5
Affiliations
Observational Study

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

Christer Janson et al. Respir Res. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Cost; Health care resource utilization; Oral corticosteroids; Severe asthma; Uncontrolled asthma.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the regional ethics committee in Uppsala, Sweden (reference number 2014/446).

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: C. Janson has received honoraria for lectures from AstraZeneca, TEVA and Novartis. K. Larsson has received honoraria for participation in advisory board meetings and lectures from AstraZeneca, Boehringer Ingelheim, Novartis, Chiesi, Orion and Takeda. B. Ställberg has served in advisory board meetings, development of educational presentations and for lectures from AstraZeneca, Novartis, Boehringer Ingelheim, Meda and TEVA. K. Lisspers has received speaking fees from AstraZeneca, Novartis, TEVA and Meda. G. Telg is a full-time employee of the sponsor, AstraZeneca. G. Johansson and M. Thuresson have no conflicts to report.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Asthma patients (number and percentage) a classified by OCS use during the 12-months baseline period, and b by their mean annual OCS use during follow-up
Fig. 2
Fig. 2
Mean yearly cost (Euro) during follow-up for the Non-OCS, Periodic OCS and Regular OCS groups. Data weighted according to age group
Fig. 3
Fig. 3
Age adjusted percentage of costs of asthma and OCS-associated comorbidities per 100 patient years, by Non-OCS, Periodic OCS and Regular OCS groups
See this image and copyright information in PMC

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