Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma

Jaco Voorham, Xiao Xu, David B. Price (Corresponding Author), Sarowar Golam, Jill Davis, Joanna Zhi Jie Ling, Marjan Kerkhof, Mandy Ow, Trung N. Tran

Research output: Contribution to journalArticle

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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.
Original languageEnglish
Pages (from-to)273-283
Number of pages11
JournalAllergy
Volume74
Issue number2
Early online date20 Nov 2018
DOIs
Publication statusPublished - Feb 2019

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Adrenal Cortex Hormones
Asthma
Delivery of Health Care
Costs and Cost Analysis
Incidence
Secondary Care
General Practice
Health Care Costs
Type 2 Diabetes Mellitus
Control Groups

Keywords

  • adverse outcomes
  • asthma
  • healthcare costs
  • healthcare resource utilization
  • systemic corticosteroids

Cite this

Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. / Voorham, Jaco; Xu, Xiao; Price, David B. (Corresponding Author); Golam, Sarowar; Davis, Jill; Zhi Jie Ling, Joanna; Kerkhof, Marjan; Ow, Mandy; Tran, Trung N.

In: Allergy, Vol. 74, No. 2, 02.2019, p. 273-283.

Research output: Contribution to journalArticle

Voorham, J, Xu, X, Price, DB, Golam, S, Davis, J, Zhi Jie Ling, J, Kerkhof, M, Ow, M & Tran, TN 2019, 'Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma' Allergy, vol. 74, no. 2, pp. 273-283. https://doi.org/10.1111/all.13556
Voorham, Jaco ; Xu, Xiao ; Price, David B. ; Golam, Sarowar ; Davis, Jill ; Zhi Jie Ling, Joanna ; Kerkhof, Marjan ; Ow, Mandy ; Tran, Trung N. / Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. In: Allergy. 2019 ; Vol. 74, No. 2. pp. 273-283.
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AU - Voorham, Jaco

AU - Xu, Xiao

AU - Price, David B.

AU - Golam, Sarowar

AU - Davis, Jill

AU - Zhi Jie Ling, Joanna

AU - Kerkhof, Marjan

AU - Ow, Mandy

AU - Tran, Trung N.

N1 - Editorial support was provided by Mike Jaqua, PhD, and AlanSaltzman, PhD, of JK Associates, Inc., and Michael A. Nissen, ELS, ofAstraZeneca. This support was funded by AstraZeneca.

PY - 2019/2

Y1 - 2019/2

N2 - 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.

AB - 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.

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