Healthcare resource utilisation associated with intermittent oral corticosteroid use in asthma

Background: Oral corticosteroids (OCS) are widely prescribed for asthma exacerbations; however, little is known about the healthcare burden of intermittent OCS use. We assessed the association between different patterns of intermittent OCS use and healthcare resource utilisation (HCRU) and cost in patients with asthma.

Methods: Historical cohort study of UK patients ≥4 years old using the Clinical Practice Research Datalink (2008–2019). Patients receiving intermittent OCS were categorised by OCS prescribing pattern based on prescription gaps (only 1 [once-only], >1 with any gaps >90-days but no gaps <90-days [less frequent], and >1 with <90-day gap(s) [frequent]) and indexed on the first intermittent OCS prescription within 3 months of an asthma-related event; OCS-naïve patients matched on gender, age, and index date served as controls. We excluded patients with long-term OCS use, chronic conditions treated with OCS, or adverse events pre-index. HCRU (general practitioner [GP], outpatient and Accident and Emergency [A&E] visits, hospitalisations, admissions, and prescriptions) and cost were compared for OCS and non-OCS use (Mann-Whitney test) and for intermittent OCS use patterns (Chi-squared test). Cost sources were Personal Social Services Research Unit 2020 for GP and outpatient visits and hospitalisations; NHS National Cost Collection 2019/20 for A&E visits; Prescription Cost Analysis 2018 for prescriptions.

Results: Of 763,136 patients with asthma receiving an OCS prescription, 149,191 met eligibility criteria (52.6% female, mean age 38.7). 50.3%, 27.4%, and 22.3% had once-only, less frequent, and frequent pattern of OCS use during follow-up, respectively; 149,191 OCS-naïve patients were included. Frequency of GP, outpatient and A&E visits, hospitalisations, and admissions (including and excluding day cases) were higher in OCS versus OCS-naïve patients, and increased with more frequent patterns of intermittent OCS use (Table). Similar results were observed for average cost per patient for all visit types (total average cost £10,329.16 vs £5,215.87; Table).

Conclusion: In patients with asthma, intermittent OCS use was associated with increased HCRU and associated costs versus non-OCS use. More frequent patterns of OCS use were also associated with a higher burden on healthcare resources, suggesting that intermittent OCS use in the management of asthma should be limited when possible.