PRS6 - Comparison of Health Care Utilization And Cost Depending on The Severity of Asthma in Adults: Analysis of The Korean National Health Insurance Claims Database

Abstract

This study attempts to estimate the proportion of patients, healthcare utilization, cost and frequency of acute exacerbations depending on the severity of asthma in adults using National Health Insurance(NHI) claims database. NHI claims database(2014) has 3% of national patient sample which is extracted using a stratified randomized sampling method. Asthma patients were defined as those who were diagnosed with asthma in adults and prescribed more than one anti-asthma medications(n=48,979 patients). Patients were divided into 3 different levels of asthma. In each 3 levels, we estimated acute exacerbations respectively, and the frequency and cost of acute exacerbations were compared. The result showed that 85.0% of patients were in level 1, 14.6% in level 2, and 0.4% in level 3. Also, the rate of steroid burst, visiting emergency department(ED), and hospitalization increased as the severity increased. Level 2 had 1.6 times more steroid burst, 3.7 times more ED visits, and 6.4 times more hospitalizations than level 1. Level 3 had 2.4 times more steroid burst, 3.8 times more ED visits, and 5.3 times more hospitalizations than level 2. There was a significant gap between level 1 and 3. The insured medical costs per visit were $22.7, $32.9, $37.8(p<0.0001) for steroid burst, and ED visit costs were $66.9, $103.1, $103.1(p<0.0001) in level 1, 2, 3 respectively. The cost of hospitalization were $1,286.1, $1,320.0, $1,915.0(p<0.0001) and period of being hospitalized were 9.1, 9.5, 14.1 days(p<0.0001). Health service utilization and cost per rate of acute exacerbations are related to the severity of asthma. The difference of cost for outpatient visits such as steroid bursts or ED visits was higher between level 1 and 2. Especially, the frequency of acute exacerbations, hospitalization cost and period were remarkably higher in level 3. Thus, asthma patients in level 3 should be aware of acute exacerbations and its prevention.