Asthma-related Healthcare Resource Use Research Articles

Changing high-risk asthma in Memphis through partnership: Results from the CHAMP program

BackgroundChildren in metro Shelby County, Tennessee, have disproportionally high asthma-related health care resource use (HRU) compared with those in other regions in Tennessee. ObjectiveTo describe the goals, logistics, and outcomes of the Changing High-Risk Asthma in Memphis through Partnership (CHAMP) program implemented to improve pediatric asthma care in Shelby County. MethodsCHAMP established a multidisciplinary team with dedicated medical staff and community health workers, implemented a 24/7 call line to improve access to care, established a patient data registry to address fragmented care, assigned community health educators to improve asthma education and social needs, and partnered with services to address environmental triggers and social determinants of health. Patients eligible for CHAMP are Shelby County residents aged 2 to 18 years with high-risk asthma enrolled in Tennessee's Medicaid managed care program. Health care resource use outcomes 1-year pre- and post-CHAMP enrollment were analyzed for patients who had completed 1 year of CHAMP between January 2013 and December 2022. The 24/7 call line data between November 2013 and December 2022 were analyzed. ResultsCHAMP has enrolled 1348 children; 945 have completed 1 year (63% male; 90% identified as Black). At 1-year post-CHAMP enrollment, patients had 58%, 68%, 42%, and 53% reductions in emergency department visits, inpatient and observation visits, urgent care visits, and total asthma exacerbations, respectively. The number of asthma exacerbations per patient significantly decreased from 2.97 to 1.40 at 1-year post-CHAMP enrollment. Of the calls made to the 24/7 call line, 58% occurred after hours and 52% led to issue resolution without a medical facility visit. ConclusionCHAMP successfully decreased asthma HRU in children with high-risk asthma in Shelby County by implementing initiatives that targeted barriers to asthma care.

EPH254 Changes in Asthma-Related Healthcare Resource Use in Asthma Patients in the United States During the COVID-19 Pandemic

EPH254 Changes in Asthma-Related Healthcare Resource Use in Asthma Patients in the United States During the COVID-19 Pandemic

Asthma-Related Healthcare Resource Use And Costs In Patients With Documented Food Allergies

Asthma is a common comorbidity in patients with food allergy (FA) leading to significant burden on patients. We quantified healthcare resource use (HRU) and medical costs related to asthma in patients with documented FA.

Clinical Outcomes and Health-Care Resource Use Associated With Reslizumab Treatment in Adults With Severe Eosinophilic Asthma in Real-World Practice

Reslizumab, an anti-IL-5 monoclonal antibody, is indicated as add-on maintenance treatment for adults with severe eosinophilic asthma. What are the real-world outcomes associated with reslizumab use in patients with severe eosinophilic asthma in a US clinical practice? In this retrospective study, patient-level data from adults treated with reslizumab were obtained from center- and panel-based medical chart reviews. Eligible patients had available medical records and treatment history for≥ 6months before initiation of reslizumab treatment (index date) to≥ 7months after reslizumab initiation. The primary outcome was response to reslizumab treatment, based on clinical expert predefined definitions of response. Other outcomes included clinical asthma exacerbations (CAEs), use of maintenance oral corticosteroids (OCS), FEV1 percent predicted, Asthma Control Test (ACT) score, and health-care resource use (HRU). Medical charts were obtained for 215 patients. Most patients (58.6%) showed an excellent response, 16.3%showed a clinically meaningful response, 21.9%showed a partial response, and 3.3%were nonresponders or treatment failures. A significant reduction was observed in the proportion of patients experiencing a CAE in a 6-month period (from 86.0%to 40.5%; P< .001) and in the mean number of CAEs per patient (2.84 [SD, 2.41] vs0.94 [SD,1.86]) after reslizumab initiation. Improvements were observed in FEV1 percent predicted (65.1%[SD, 20.5%] vs73.1%[SD, 23.1%]; P< .001) and in ACT scores (13.8 [SD, 4.2] vs18.6 [SD, 4.0]; P< .001) before to after reslizumab initiation. Among patients using maintenance OCS at baseline, more than half discontinued use of these by approximately 10months after reslizumab initiation. Significant reductions in asthma-related HRU were observed after reslizumab initiation. In clinical practice, reslizumab may have been initiated in response to heavy symptom burden and CAEs. Reslizumab was associated with improved clinical and patient-reported outcomes and significant reductions in asthma-related HRU.

Direct costs of overdiagnosed asthma: a longitudinal, population-based cohort study in British Columbia, Canada

ObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden...

Reduced Asthma Exacerbations and Asthma-Related Healthcare Resource Use with Omalizumab from the Real-World PROSPERO Study

Reduced Asthma Exacerbations and Asthma-Related Healthcare Resource Use with Omalizumab from the Real-World PROSPERO Study

The Burden of Severe Asthma in France: A Case-Control Study Using a Medical Claims Database

Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long-term outcomes, and costs of SA. To provide accurate information on SA, focusing on comorbidities, mortality, health care resource consumption, and associated costs. A cohort of patients with SA identified in 2012 was extracted from a French representative claims database and followed for 3 years. Their characteristics, comorbidities, mortality, and direct costs were compared with a matched control group without asthma. A total of 690 patients with SA were matched to 2070 patients without asthma (mean age, 61 years; 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population. Comorbidities were more frequent in patients with SA (73.9% suffered from cardiovascular disease vs 54.3% in controls; P < .001). A total of 58.7% of patients with SA used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 boxes/year/patient and 9% received ≥6 dispensings of OCS. A total of 6.7% were treated by omalizumab. Patients with SA were more frequently hospitalized (33.2% vs 19.7%; P < .001), more frequently consulted a general practitioner (97.8% vs 83.9%; P < .001) (9.8 ± 6.8 vs 6.2 ± 5.3 consultations/year; P < .001), and 31% have consulted a private respiratory physician. Compared with controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%; P= .007). Direct medical cost was $9227 versus $3950 (P < .001) mostly driven by medication costs. The prevalence of SA in the French adult population is at least 18 of 10,000. Burden of disease is high with respect to comorbidities, mortality, and asthma-related health care resource use.

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

BackgroundLittle is known about the prevalence of severe, uncontrolled eosinophilic asthma (SUEA) and associated costs.AimsWe sought to determine the prevalence of SUEA and compare asthma-related healthcare resource use (HCRU) and...

Economic Burden of Illness Among Patients with Severe Asthma in a Managed Care Setting.

Despite intensive pharmacotherapy, a considerable number of patients with severe asthma have inadequate disease control. Patients with severe asthma who experience exacerbations consume significant health care resources. To assess health care resource utilization and associated costs among patients with persistent severe asthma who experienced exacerbations compared with patients with persistent but nonsevere asthma. This retrospective analysis of a national administrative claims database identified patients aged ≥ 12 years who had at least 1 medical claim with an asthma diagnosis in 2012 and had continuous medical and pharmacy coverage under a commercial or Medicare Advantage plan from January 1, 2012, to December 31, 2013. Patients were assigned to 1 of 2 mutually exclusive cohorts-persistent asthma (PA) or severe asthma (SA)-according to an established algorithm based on asthma-related health care resource use and pharmacy claims for controller medication. SA patients were required to meet PA criteria and also have evidence of ≥2 asthma exacerbations in 2012. Asthma-related health care resource utilization and costs were computed from asthma medication use (rescue and controller therapy) and medical claims with an asthma diagnosis in the primary position in 2012 and 2013. Adherence to controller therapy was assessed over 365 days by using the proportion of days covered (PDC), starting with the first claim for controller therapy in 2012. Differences between the PA and SA cohorts were analyzed by t-test for continuous variables and chi-square test for categorical variables. Asthma-related costs in 2013 were also analyzed using a generalized linear model with a gamma distribution and log link, adjusted for patient demographics (age, gender, region, and insurance type) and Quan-Charlson comorbidity score. A total of 65,359 patients were included: 63,597 (97.3%) PA patients and 1,762 SA patients (2.7%). Compared with the PA cohort, the SA cohort was older (mean age = 50.8 years vs. 46.5 years, P < 0.001) and had higher mean comorbidity score (1.47 vs. 1.31, P< 0.001). The mean count of all asthma medications fills was 2.2-fold (2012) and 2.1-fold (2013) higher in the SA cohort, compared with the PA cohort (P< 0.001). Mean PDC for all oral and inhaled controller therapy was also higher in the SA cohort compared with the PA cohort (0.80 vs. 0.65, P< 0.001). SA patients had a significantly greater mean count of asthma-related hospitalizations, emergency room visits, and ambulatory visits in 2012 and 2013 (P< 0.001). Unadjusted mean annual asthma-related costs in the SA versus PA cohorts were $6,496 versus $2,739 (P < 0.001) in 2012 and $5,174 versus $1,775 (P< 0.001) in 2013. Higher asthma-related costs were driven by greater mean annual asthma medication costs in 2012 ($4,545 vs. $1,738, P< 0.001) and 2013 ($4,068 vs. $1,348, P< 0.001). Adjusted mean annual asthma-related costs in 2013 were $3,336 greater (cost ratio=2.878, P< 0.001) in the SA cohort, and adjusted mean annual asthma medication costs were $2,672 higher (cost ratio=2.982, P< 0.001) in the SA cohort. Patients with SA who experienced 2 or more exacerbations had 2.1-fold greater use of controller medications across both study years and were more adherent to controller therapy than patients with PA. Despite more intensive pharmacotherapy, SA patients incurred 2.9-fold higher adjusted asthma-related costs and 3-fold higher adjusted asthma medication costs than PA patients. Patients with SA consistently demonstrated a higher rate of health care utilization. Funding for this study (HO-14-14443) was provided by GlaxoSmithKline (GSK). All listed authors meet the criteria for authorship set forth by the International Committee for Medical Journal Editors. Albers, Forshag, and Yancey are employees of GSK and hold stock in GSK. Dalal, Nagar, and Ortega were employees of GSK at the time this research was conducted. Chastek and Korrer are employees of Optum, which received consulting fees from GSK for research related to this study. Study concept and design were contributed by Chastek, Nagar, and Dalal. Korrer took the lead in data collection, along with Chastek, and data interpretation was performed by Chastek, Ortega, Forshag, and Dalal. The manuscript was written by Chastek and Dalal and revised by Albers and Yancy, assisted by the other authors.

Prescribing patterns of asthma controller therapy for children in UK primary care: a cross-sectional observational study

BackgroundAsthma management guidelines recommend a stepwise approach to instituting and adjusting anti-inflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting.MethodsData from the UK General Practice Research Database were examined for children with recorded asthma or recurrent wheezing who, from September 2006 through February 2007, were ≤ 14 years old at the time of a first asthma controller prescription after ≥ 6 months without a controller prescription. We evaluated demographic characteristics, asthma duration, comorbidities, asthma-related health care resource use, and prescribed daily dose of controller medication. In addition, physicians for 635 randomly selected patients completed a survey retrospectively classifying asthma severity at the prescription date and describing therapy and health care utilization for 6 prior months.ResultsWe identified 10,004 children, 5942 (59.4%) of them boys, of mean (SD) age of 8.0 (3.8) years. Asthma controller prescriptions were for inhaled corticosteroid (ICS) monotherapy for 9059 (90.6%) children; ICS plus long-acting β2-agonist (LABA) for 698 (7.0%); leukotriene antagonist monotherapy for 91 (0.9%); ICS plus leukotriene antagonist for 55 (0.6%); and other therapy for 101 (1.0%), including 45 (0.45%) children who were prescribed LABA as monotherapy. High doses of ICS (> 400 μg) were prescribed for 44/2140 (2.1%) children < 5 years old and for 420/7452 (5.6%) children ≥ 5 years. Physicians reported asthma severity as intermittent for 346/635 (55%) patients and as mild, moderate, and severe persistent for 159 (25%), 71 (11%), and 11 (2%), respectively (severity data missing for 48 [8%]). The baseline characteristics and controller therapy prescriptions of the survey cohort were similar to those of the full cohort.ConclusionsPhysician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose ICS or add-on LABA was prescribed even in intermittent and mild disease. In UK primary care, monotherapy with ICS is the most common controller therapy at all levels of asthma severity.

Asthma-Related Health Care Resource Use Among Asthmatic Children With and Without Concomitant Allergic Rhinitis

Purpose of the Study. To determine the incremental effect of allergic rhinitis on health care resource use in children with asthma. Study Population. Children (aged 6–15 years) with asthma and &amp;gt;1 asthma-related encounter with a general practitioner (GP) during a 12-month follow-up period were included from the United Kingdom medical plus general-practice database, including 2 million office patient visits per year to &amp;gt;500 GPs. Methods. This was a population-based historical cohort investigation. Asthma and allergic rhinitis were determined by diagnosis codes and drug codes for appropriate medications. Results. Of 9522 children with asthma, 1879 (19.7%) had allergic rhinitis recorded in the GP medical charts. Compared with children with asthma alone, children with comorbid allergic rhinitis experienced more GP visits (4.4 vs 3.4) and more of them were hospitalized for asthma (1.4% vs 0.5%) during the 12-month follow-up period. In multivariable regression analyses, comorbid allergic rhinitis was an independent predictor of hospitalization for asthma (odds ratio: 2.34; 95% confidence interval [CI]: 1.41–3.91) and was associated with increases in the number of asthma-related GP visits (mean increase: 0.53; 95% CI: 0.52–0.54) and asthma drug costs (mean increase [British pounds]: £6.7; 95% CI: £6.5–£7.0). The association between allergic rhinitis and higher costs of prescriptions for asthma drugs was independent of asthma severity, measured indirectly by the intensity of use of asthma drugs. Conclusions. Children with comorbid allergic rhinitis incurred greater prescription drug costs and experienced more physician visits and hospitalizations for asthma than did children with asthma alone. A unified treatment strategy for asthma and allergic rhinitis, as recommended by the Allergic Rhinitis and Its Impact on Asthma initiative, might reduce the costs of treating these conditions. Reviewer Comments. This is a useful study emphasizing the impact of allergic rhinitis on asthma, with implications for better therapeutic approaches. The study may have actually underestimated the impact of allergic rhinitis, because the data are retrospective and diagnosed allergic rhinitis was estimated at only 19.7%, compared with rates as high as 50% among children with asthma in other studies.

Patterns of asthma-related health care resource use in children treated with montelukast or fluticasone

ABSTRACTObjective: To examine the impact of controller monotherapy with montelukast or fluticasone on asthma-related health care resource use among children aged 2–14 years old.Design and methods: A retrospective claims-based analysis of asthmatic children, 2–14 years old, receiving a prescription (index) for montelukast or fluticasone between January 1, 1999 and June 30, 2000 was conducted. Children were matched by age and propensity score to obtain comparable treatment groups. The propensity score was derived using patient demographics, pre-existing respiratory conditions, and asthma-related pharmacy and health service utilization (i.e. ambulatory visits, emergency department visits and hospitalizations). Claims for asthma-related emergent care and medication use were examined for the 12‐month periods before and after the index prescription. Treatment group comparisons of asthma-related resource use were conducted for the total pediatric population and separately for children 2–5 years and 6–14 years. Persistent controller medication use was assessed at 6 and 12 months post-index.Results: A total of 2034 children were matched (1017 in each treatment group). Post-index rates of asthma-related resource use were similar among children treated with montelukast or fluticasone. Among children 2–5 years old, fewer emergency department visits were observed with montelukast versus fluticasone (relative risk = 0.52, 95% confidence interval [CI]: 0.28–0.96); no significant difference was observed among children 6–14 years old. No significant differences between montelukast and fluticasone cohorts in hospitalizations or rescue medication fills were noted in either age group. Evidence of at least one medication refill was significantly greater with montelukast at both 6 and 12 months post-index.Conclusions: Similar levels of resource use were achieved by children 2–14 years initiating montelukast or fluticasone, as indicated by use of asthma-related emergent care and rescue/acute medications. Subgroup analyses suggest a differential effect of age on the relationship between treatment and asthma-related resource use, with children 2–5 years observed to have less resource use while on montelukast.

Cost of scheduled and unscheduled asthma management in seven European Union countries

Frequent need for emergency healthcare indicates poor asthma control and consumes resources that might be better spent on improved management. This study estimated the cost of scheduled and unscheduled healthcare for asthma in seven European Union (EU) countries.The occurrence of asthma-related healthcare resource use and asthma symptom severity were identified from a telephone sample of people with asthma in France, Germany, Italy, the Netherlands, Spain, Sweden and the UK. Healthcare resource use was multiplied by country-specific unit costs to estimate per patient annual expenditure. Patients were divided into four groups according to asthma symptom severity: mild intermittent symptoms, mild persistent symptoms, moderate persistent symptoms and severe persistent symptoms. Cost was divided between scheduled and unscheduled care. Drug cost was not evaluable.The study included 2,803 patients, of whom 1,695 (60%) reported mild symptoms and 2,050 (73%) were aged ≥16 yrs. The average annual per patient cost was €789 for patients aged 0–4 yrs, €463 for patients aged 5–15 yrs and €566 for adults. Unscheduled care accounted for 47% of total cost in infants, 45% in children and 56% in adults.Around half of expenditure on asthma management was found to be due to unscheduled care regardless of the severity of patient symptoms.

Asthma-Related Health Care Resource Use Among Patients Starting Fluticasone or Montelukast Therapy

To compare patterns of asthma-related health care resource use among patients prescribed fluticasone or montelukast as singlecontroller therapy for asthma, and to confirm patterns previously observed in retrospective analyses examining outcomes among patients receiving fluticasone or montelukast for asthma. Retrospective cohort study. Administrative claims data drawn from United States health insurers in 35 states, covering 17 million privately insured patients. PATIENTS; A total of 4758 patients aged 2-55 years with asthma who were prescribed either fluticasone or montelukast from July 1, 1998-June 30, 1999, were continuously enrolled for at least 24 months, had no evidence of controller therapy for 6 months before the start of drug therapy, and had no evidence of chronic obstructive pulmonary disease or other respiratory illness. Patients were identified using an algorithm based on medical and pharmacy insurance claims. Patients were matched between groups based on a propensity score of clinical characteristics and age; this resulted in 1512 patients/treatment group. Asthma-related health care claims incurred for 12 months before and after the start of controller therapy were analyzed. After adjustment, the fluticasone-treated group had greater risk than the montelukast-treated group of requiring therapy with a short-acting beta-agonist in the follow-up period (relative risk 1.12, 95% confidence interval [CI] 1.03-1.20). Odds were similar across treatment groups for needing an emergency department visit and/or hospitalization (odds ratio 1.08, 95% CI 0.74-1.58) and for needing therapy with an oral corticosteroid (odds ratio 1.02, 95% CI 0.84-1.26). The start of therapy with either fluticasone or montelukast as a single-controller for asthma was associated with similar asthma-related health care resource use in this matched population.

Unscheduled healthcare resource use among asthma patients receiving low-dose inhaled corticosteroids maintenance treatment

This survey describes asthma control and unscheduled healthcare resource use (HCRU) among patients receiving low-dose inhaled corticosteroids (ICS) alone in five European countries and the USA. Physicians and patients completed forms collecting data on asthma symptoms, sudden increase in chest/respiratory symptoms, asthma-related HCRU, quality of life (QoL) and drug therapy. Fifty-seven per cent of patients on low-dose ICS alone had physician-rated moderate or severe asthma. Only 13% of patients receiving low-dose ICS alone achieved asthma control; 36% reported nocturnal wakening and 22% reported unscheduled healthcare services in the past year. Gender, symptom frequency, episodes of sudden increase in chest/respiratory symptoms and impaired QoL were all related to unscheduled healthcare resource utilisation. Many patients receiving low-dose ICS alone do not have adequate asthma control. Some patient characteristics were found to be significantly different, but not exclusive, between unscheduled healthcare resource users and non-users.

Asthma-Related Health Care Resource Use Among Asthmatic Children With and Without Concomitant Allergic Rhinitis

To determine the incremental effect of allergic rhinitis on health care resource use in children with asthma. Population-based historical cohort study. Data in a general practice database in the United Kingdom during 1998 to 2001. Children 6 to 15 years old with asthma and with >or=1 asthma-related visits to a general practitioner (GP) during a 12-month follow-up period. Asthma-related hospitalizations, GP visits, and prescription drug costs during the 12-month follow-up period for patients with and without comorbid allergic rhinitis. Of 9522 children with asthma, 1879 (19.7%) had allergic rhinitis recorded in the GP medical records. Compared with children with asthma alone, children with comorbid allergic rhinitis experienced more GP visits (4.4 vs 3.4) and more of them were hospitalized for asthma (1.4% vs 0.5%) during the 12-month follow-up period. In multivariable regression analyses, comorbid allergic rhinitis was an independent predictor of hospitalization for asthma (odds ratio: 2.34; 95% confidence interval [CI]: 1.41-3.91) and was associated with increases in the number of asthma-related GP visits (mean increase: 0.53; 95% CI: 0.52-0.54) and asthma drug costs (mean increase pound: 6.7; 95% CI: 6.5-7.0). The association between allergic rhinitis and higher costs of prescriptions for asthma drugs was independent of asthma severity, measured indirectly by the intensity of use of asthma drugs. Children with comorbid allergic rhinitis incurred greater prescription drug costs and experienced more GP visits and hospitalizations for asthma than did children with asthma alone. A unified treatment strategy for asthma and allergic rhinitis, as recommended by the Allergic Rhinitis and Its Impact on Asthma initiative, might reduce the costs of treating these conditions.