OVERLAP OF ASTHMA WITH ABPA AND EGPA BY DISEASE SEVERITY, EOSINOPHIL LEVELS, HEALTH CARE RESOURCE UTILIZATION, AND COSTS

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Eosinophilic immune dysfunction (EID) is the dysregulation of mechanisms of eosinophil recruitment and activation, which may be a key mediator of many eosinophilic-driven diseases (EDDs). The overlap of asthma and other respiratory EDDs is not well understood.We aimed to quantify the overlap of asthma and allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA) according to asthma severity. We also examined eosinophil levels, health care resource utilization (HCRU), and total costs in patients with and without disease overlap. METHODS: REal-world inVestigation of Eosinophilic-Associated disease overLap (REVEAL) is a retrospective study using Optum Clinformatics claims data. Diagnoses and disease severity were determined from International Classification of Diseases (ICD) codes. REVEAL included data from patients with ≥2 years of continuous health plan enrollment and at least one diagnostic code for selected respiratory and eosinophilic diseases of interest. This analysis included 406,573 patients with asthma, 702 with EGPA, and 881 with ABPA during the period from January 1, 2015 to June 30, 2019. Descriptive statistics were used to analyze disease overlap. RESULTS: Of 406,573 patients with asthma, 588 (0.14%) had comorbid ABPA and 310 (0.08%) had comorbid EGPA. Disease overlap rates were greater for severe asthma than for mild to moderate asthma. (Severe asthma was defined as patients with a prescription for oral corticosteroids, an emergency room [ER] visit or inpatient hospitalization with a primary diagnosis code for asthma, or use of biologic therapy for asthma.) Of patients with mild to moderate asthma, 430 (0.13%) had ABPA and 192 (0.06%) had EGPA; of patients with severe asthma, 158 (0.23%) had ABPA and 118 (0.17%) had EGPA. High eosinophil levels (≥500 cells/µL) were more frequent in patients with asthma and ABPA (24.7%) or EGPA (24.8%) than in those with asthma alone (8.4%). All-cause HCRU per patient per month (including hospitalizations, inpatient length of stay [LOS], ER visits, and outpatient visits) and total all-cause costs (2020 US$) were higher in patients with asthma and ABPA or asthma and EGPA than in those with asthma alone (hospitalizations [mean]: 0.5 and 0.6 vs. 0.2; LOS [days]: 0.9 and 1.2 vs. 0.5; ER visits: 0.2 and 0.2 vs. 0.1; outpatient visits: 2.6 and 2.9 vs. 1.2; and costs: $8499.10 and $10,047.90 vs. $2628.80, respectively). CONCLUSIONS: We observed that asthma patients with comorbid ABPA or EGPA had more severe disease, greater levels of eosinophilia, and increased HCRU and costs, suggesting a central role of EID in disease severity. CLINICAL IMPLICATIONS: These findings have implications for quantifying unmet need, informing diagnostic and treatment approaches, and raising awareness about the role of EID in driving the development of multiple related conditions. DISCLOSURES: Employee relationship with AstraZeneca Please note: Aug 2020 to present Added 04/27/2021 by Anamaria Brailean, source=Web Response, value=Salary Employee relationship with AstraZeneca Please note: Aug 2020 to present Added 04/27/2021 by Anamaria Brailean, source=Web Response, value=Ownership interest Employee relationship with astrazeneca Please note: current Added 04/30/2021 by Rohit Katial, source=Web Response, value=Salary Employee relationship with AstraZeneca Please note: 2019 Added 05/10/2021 by Danuta Kielar, source=Web Response, value=Salary Employee relationship with Evidera Please note: Oct 2020 Onward Added 04/27/2021 by Yong Jin Kim, source=Web Response, value=Salary Consultant relationship with AstraZeneca Please note: October 2020 Onward Added 04/27/2021 by Yong Jin Kim, source=Web Response, value=Consulting fee Employee relationship with AstraZeneca Please note: 2014-current Added 04/27/2021 by Justin Kwiatek, source=Web Response, value=Salary No relevant relationships by Sharon MacLachlan, source=Web Response Employee relationship with AstraZeneca Please note: full time employee Added 04/28/2021 by Heide Stirnadel-Farrant, source=Web Response, value=Salary No relevant relationships by Michael Stokes, source=Web Response Employee relationship with AstraZeneca Please note: 2008 - now Added 04/27/2021 by Xiao Xu, source=Web Response, value=Salary