Research Looks at Links Among Asthma Control, Economic Outcomes, Medication Use

Two abstracts presented Saturday at the American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting, held February 22-25 in San Francisco, California, covered various links among economics, asthma control, and medication use.

Last year, the CDC estimated the economic burdens of asthma at $80 billion a year, but that study did not account for nonmedical costs, such as diminished work productivity.

Asthma Control Test and Economic Outcomes

In the first abstract, researchers used the Asthma Control Test (ACT) to look for links to economic outcomes and found that those with worse ACT scores used more healthcare resources and had greater losses in work productivity.

Patients aged 18 years or older with a self-reported physician diagnosis of asthma were identified from the 2015-2016 US National Health and Wellness Survey, a patient-administered, internet-based questionnaire. They were grouped into 3 levels of asthma control using the ACT score, with a score of 15 or below considered poorly controlled, 16 to 19 partly controlled, and 20 to 25 well controlled.

Researchers used the Work Productivity and Activity Impairment-General Health Scale and patient-reported health resource utilization (HRU) including healthcare provider visits, emergency department visits, and hospitalizations in the previous 6 months to derive indirect and direct healthcare costs, respectively.

Lower ACT scores were associated with greater HRU and work productivity loss, according to the results. Improving asthma control with interventions may result in direct and indirect cost savings, the researchers wrote.

Overall, 1360 (17.4%) had poorly-controlled asthma, 1572 (20.1%) had partly controlled asthma, and 4888 (62.5%) had well-controlled asthma.

For those with poorly controlled asthma, mean work impairment was higher (P <.001) in patients with ACT scores of 15 or below (44.65%) and for those with partly controlled asthma (almost 32%) versus patients with well-controlled asthma (19.12%).

All HRU outcomes were also higher for patients with poor and partly controlled asthma compared with those for patients with well-controlled asthma (P <.02 for all outcomes).

Mean indirect and direct costs were significantly higher for patients with poorly controlled asthma ($14,764; P <.001; and $15,262; P <.001, respectively) and moderately controlled asthma ($10,448; P <.001; $8554; P = .001) versus patients with well controlled asthma ($6353 and $6012).

Healthcare Costs and Medication Use

In the second abstract, researchers provided updated healthcare costs of patients with moderate to severe asthma (MSA) receiving medium-to-high-dosage combined inhaled corticosteroid (ICS) and a long-acting β agonist (LABA), a combination known as ICS/LABA, with and without exacerbations and/or high rescue medication use (Ex/R). Cost differences between MSA and non-MSA patients were primarily driven by the subgroup of MSA patients with Ex/R, partly because of asthma-related pharmacy expenditures.

Researchers used US administrative claims from the IBM MarketScan Research Databases and included patients with asthma aged 12 years or older with records between January 1, 2012, and December 31, 2015. Patients were indexed on their earliest medical claims for asthma. They were required to have had evidence of 2 or more years of continuous eligibility.

To be classified as having moderate to severe asthma, patients were required to have MSA, 1 or more medium-or high-dosage ICS/LABA claim, 1 or more omalizumab claim, or systemic corticosteroid supply covering 50% or more of the 12-month baseline period. Healthcare costs were measured during the 12-month postindex period.

The study identified 605,614 total patients with asthma;: 92,027 (15.2%) had MSA and 37,220 (6.1%) had MSA and Ex/R. Compared with non-MSA patients, MSA patients incurred greater total ($15,244 vs $10,860) and asthma-related ($3853 vs $1670) healthcare costs during the 12-month follow-up period.

In addition, MSA patients with Ex/R incurred greater total healthcare costs than MSA patients without Ex/R ($18,233 vs $13,215), as well as greater asthma-related pharmacy expenditures ($2160 vs $327).

References

1. Lee LK, Ramakrishnan K, Safioti G, et al. Asthma control test score Abstract presented at: is associated with economic outcomes among U.S. asthma patients. Presented at: American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting; February 22-25, 2019; San Francisco, CA. Abstract 155.

2. Settipane RA, Kreindler J, Chung Y, Tkacz J. Economic burden of asthma patients on medium- to-high-dosage ICS/LABA, with and without exacerbations: US administrative claims database analyses. Presented at: American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting; February 22-25, 2019; San Francisco, CA. Abstract 157.