Increased use of corticosteroids associated with complications and high costs
Published online: July 14, 2020
A variety of therapeutic options are available for the treatment of persistent asthma, with systemic corticosteroids (SCS) reserved for patients who may not achieve adequate control with traditional therapies. However, SCS treatment comes with known risks for acute and chronic complications, including osteoporosis, bone fracture, hypertension, and diabetes. From a healthcare cost perspective, it has been established that patients with severe, persistent asthma are responsible for a disproportionate amount of the economic burden of asthma; however, it is unclear what extent SCS use and its consequences specifically contribute to the cost burden of asthma.
Zeiger et al. conducted a large retrospective study using healthcare claims data to follow patients for up to 3 years after an initial treatment with SCS and compared their complication rates, health care resource utilization, and healthcare costs to similar asthma patients who were not treated with SCS. Adult patients with persistent asthma were identified in the IBM MarketScan databases from 1/2003 to 7/2016. SCS patients were followed from their initial SCS prescription date, while non-SCS patients were followed from an algorithm-matched control date (index date). All patients were required to have ≥1 year of data before and after their index date. Patients were categorized into 3 SCS groups: 0 SCS claims, 1‒3 SCS claims (low dose SCS), and 4+ SCS claims (high-dose SCS). Statistical analyses included weighted and multivariate modeling to assess SCS-related complications and costs during a 3-year follow-up. The results of this study were recently published in The Journal of Allergy and Clinical Immunology: In Practice.
A total of 86,786 SCS users and 91,409 non-SCS users were included in the analysis; 45% remained 3 years post-index. The 3-year risk of developing any chronic complication was 6% higher for patients with low dose SCS use and 26% higher for those with high dose SCS use compared with non-SCS users. Additionally, over the 3-year follow-up, compared to control patients, high dose SCS patients incurred $22,311 higher total healthcare costs, $4,627 higher asthma-related costs, and $2,647 higher chronic complication-related costs.
This study shows that adult patients with persistent asthma treated with SCS are more likely to develop SCS-associated complications and higher healthcare costs up to 3 years after exposure, and that these relationships will be dose-dependent, with each increasing as the exposure to SCS increases. Results highlight the clinical and economic consequences of SCS treatment for persistent asthma and should raise awareness of the potential benefits of minimizing SCS use in persistent asthma whenever possible.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.