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Asthma
Original Article
Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population
  1. Marjan Kerkhof1,
  2. Trung N Tran2,
  3. Joan B Soriano3,
  4. Sarowar Golam4,
  5. Danny Gibson5,
  6. Elizabeth V Hillyer1,
  7. David B Price1,6
  1. 1Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
  2. 2Medical Evidence and Observational Research, AstraZeneca, Gaithersburg, Maryland, USA
  3. 3Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
  4. 4Global Payer Evidence and Pricing, AstraZeneca, Gothenburg, Sweden
  5. 5AstraZeneca UK Ltd, Luton, UK
  6. 6Academic Primary Care, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Professor David B Price, Academic Primary Care, University of Aberdeen, Aberdeen AB25 2ZD, UK; dprice{at}opri.sg

Abstract

Background Little is known about the prevalence of severe, uncontrolled eosinophilic asthma (SUEA) and associated costs.

Aims We sought to determine the prevalence of SUEA and compare asthma-related healthcare resource use (HCRU) and associated costs with overall means for a general asthma population.

Methods This cohort study evaluated anonymised medical record data (December 1989 through June 2015) from the Clinical Practice Research Datalink and the Optimum Patient Care Research Database to study UK patients with active asthma (diagnostic code and one or more drug prescriptions in the baseline year), aged 5 years and older, without concomitant COPD, and with recorded eosinophil count. SUEA was defined as two or more asthma attacks during 1 baseline year preceding a high blood eosinophil count (≥0.3×109/L) for patients prescribed long-acting β2-agonist (LABA) and high-dosage inhaled corticosteroids (ICS) during baseline plus 1 follow-up year. We compared asthma-related HCRU and associated direct costs (2015 pounds sterling, £) during the follow-up year for SUEA versus the general asthma population.

Results Of 363 558 patients with active asthma and recorded eosinophil count, 64% were women, mean (SD) age was 49 (21) years; 43% had high eosinophil counts, 7% had two or more attacks in the baseline year and 10% were prescribed high-dosage ICS/LABA for 2 study years. Overall, 2940 (0.81%; 95% CI 0.78% to 0.84%) patients had SUEA. Total mean per-patient HCRU and associated costs were four times greater for SUEA versus all patients (HCRU and cost ratios 3.9; 95% CI 3.7 to 4.1).

Conclusions Less than 1% of patients in a general asthma population had SUEA. These patients accounted for substantially greater asthma-related HCRU and costs than average patients with asthma.

  • asthma
  • attacks
  • exacerbations
  • costs
  • eosinophils
  • observational study
  • severe uncontrolled asthma

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/thoraxjnl-2017-210531

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    Footnotes

    • Contributors MK, TNT, SG, DG and DPB: participated in the conception and design of the study. MK and DBP: participated in the acquisition and analysis of the data. EVH: developed the first draft of the manuscript. All authors: participated in the interpretation of the data, the review and revision of the manuscript, and the approval to submit.

    • Funding This study was funded by AstraZeneca. All authors, including employees of the sponsor, participated in the development of the manuscript and had access to study data.

    • Competing interests MK is an employee of the Observational and Pragmatic Research Institute Pte Ltd (OPRI), which conducted this study with funding from AstraZeneca and which has conducted paid research in respiratory disease on behalf of the following other organizations: Aerocrine, AKL Research and Development Ltd, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, Theravance, UK National Health Service and Zentiva. TNT, SG and DG are employees of AstraZeneca. JBS is a consultant to OPRI and has received pharmaceutical company grants from GSK in 2011 and Chiesi in 2012 via CIMERA his former home institution, and in 2014 and 2015 from Linde via Hospital Universitario de La Princesa; JBS participated in speaking activities, advisory committees and consultancies during the period 2011-2016 sponsored by: Almirall, AstraZeneca, Boehringer-Ingelheim, Chiesi, ERS, GEBRO, Grifols, GSK, Linde, Lipopharma, Mundipharma, Novartis, Pfizer, RiRL, Rovi, SEPAR, Takeda and Teva. EVH is a consultant to OPRI and has received fees for medical writing assistance from Merck. DBP has board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Mundipharma, Napp, Novartis and Teva Pharmaceuticals; consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, TevaPharmaceuticals, Theravance, UK National Health Service, Zentiva; payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, and Teva Pharmaceuticals; payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma and Novartis; payment for travel/accommodation/meeting expenses from Aerocrine, AstraZeneca, Boehringer Ingelheim, Mundipharma, Napp, Novartis and Teva Pharmaceuticals; funding for patient enrolment or completion of research from Chiesi, Novartis, Teva Pharmaceuticals and Zentiva; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia, Singapore, and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); and is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme and Health Technology Assessment.

    • Ethics approval CPRD Independent Scientific Advisory Committee gave approval for use of the GPRD (ISAC registration number, 15_141) and the OPCRD is approved by the Health Research Authority of the UK NHS for clinical research use (REC reference: 15/EM/0150).

    • Provenance and peer review Not commissioned; externally peer reviewed.