Robert S Zeiger1, Michael Schatz2, Anand A Dalal3, Lei Qian2, Wansu Chen2, Eunice W Ngor4, Robert Y Suruki3, Aniket A Kawatkar2. 1. Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org. 2. Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif. 3. GlaxoSmithKline, Research Triangle Park, NC. 4. Kaiser Permanente Northern California Region, Oakland, Calif.
Abstract
BACKGROUND: Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation. OBJECTIVE: The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting. METHODS: This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression. RESULTS: Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959). CONCLUSION: Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly, personalized treatment approaches including novel biologic treatments.
BACKGROUND: Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation. OBJECTIVE: The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting. METHODS: This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression. RESULTS: Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959). CONCLUSION: Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly, personalized treatment approaches including novel biologic treatments.
Authors: Paul E Moore; Jason T Poston; Debra Boyer; Emily Barsky; Jonathan Gaffin; Kathleen B Boyne; Kristie R Ross; Laura Beth Mann Dosier; Timothy J Vece; Alicia M Casey; Sebastian K Welsh; J Wells Logan; Edward G Shepherd; Pelton A Phinzy; Howard B Panitch; Christina M Papantonakis; Eric D Austin; Amir B Orandi; Maleewan Kitcharoensakkul; Mark K Abe; Amjad Horani; Jordan S Rettig; Jessica Pittman Journal: Ann Am Thorac Soc Date: 2017-08
Authors: Matthew G Drake; Elizabeth R Bivins-Smith; Becky J Proskocil; Zhenying Nie; Gregory D Scott; James J Lee; Nancy A Lee; Allison D Fryer; David B Jacoby Journal: Am J Respir Cell Mol Biol Date: 2016-09 Impact factor: 6.914
Authors: Delaney Griffiths; Lauren M Giancola; Kelly Welsh; Kristen MacGlashing; Christine Thayer; Sigfus Gunnlaugsson; Natalie P Stamatiadis; Gabriella C Sierra; Adam Hammond; Kimberly F Greco; Tregony Simoneau; Sachin N Baxi; Jonathan M Gaffin Journal: Pediatr Pulmonol Date: 2020-10-26