Published Online: October 2, 2015
The high utilization and cost of severe asthma is in disproportion to its frequency among persistent asthmatics, but little is known of the burden of severe uncontrolled asthma (SUA) in a managed care setting.
Zeiger et al report in The Journal of Allergy Clinical Immunology: In Practice an observational study that identified, characterized, and determined the clinical and economic burden of SUA compared to non-SUA in a cohort of 25,935 adolescents and adults with persistent asthma based on the Healthcare Effectiveness Data and Information Set administrative definition. The SUA subgroup was identified when all of the three following criteria were met in 2012: >2 asthma exacerbations; >6 medium- or high-dose canisters of inhaled corticosteroid (ICS) dispensed as monotherapy or with long-acting beta-2-agonist; and >3 dispensed non-ICS controllers dispensed. The non-SUA subgroup did not meet those criteria. Healthcare utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression.
Compared to the non-SUA subgroup (N=25,350, 97.7%), the SUA subgroup (N=585, 2.3%) was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During the follow-up year, SUA patients exhibited significantly more asthma exacerbations and short-acting beta-2-agonist use and higher all-cause and asthma-related costs than non-SUA patients. The adjusted asthma-related average direct cost per-patient at follow-up was significantly ($1,056/patient) higher for SUA than non-SUA patients, with asthma drugs accounting for the major incremental cost difference ($848/patient).
The results of this study suggest that SUA patients require more intensive interventions, including higher step-level care, better adherence, more specialist care, and specific attention to comorbidities, to reduce asthma burden.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician