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Health care costs, outpatient visits increase in severe asthma patients

Patients with severe asthma taking Xolair, high-intensity corticosteroids, or high-dose inhaled corticosteroids experienced annual increases in health care expenses, asthma prescriptions and outpatient visits during follow-up, according to study results.

Patrick W. Sullivan, PhD, of Regis University School of Pharmacy, and colleagues conducted a retrospective cohort study of 19,227 patients with asthma aged 12 to 75 years. The researchers sought to determine control, risk, economic, and health resource use outcomes linked to treatment escalation to steps four and five from the Global Initiative for Asthma.

“The present study presents a novel approach to understand outcomes in the severe asthma population by categorizing patients according to [Global Initiative for Asthma] treatment step,” the researchers wrote.

Patients were categorized by use of Xolair (omalizumab, Genentech; n = 856), high-intensity corticosteroids (HICS; n = 6,926) at greater than or equal to 1,000 µg inhaled fluticasone daily or oral prednisone, or high-dose inhaled corticosteroids (HDICS; n = 11,445) at 500 µg to less than 1,000 µg daily fluticasone equivalent.

Data were extracted from the 2002 to 2011 MarketScan Commercial Claims and Encounters Database.

Health care expenses increased from baseline to follow-up in all cohorts ($14,071 vs. $34,887, omalizumab; $7,570 vs. $9,826, HDICs; $12,030 vs. $15,557, HICS).

The annual number of prescriptions for asthma increased from 11.74 to 19.46 for patients taking omalizumab, 7.8 to 12.44 for those taking HICS, and 5.17 to 9.69 for patients taking HDICS.

Outpatient visits for patients using omalizumab increased from 26.79 to 34.06, 18.78 to 21.37 for HICS, and 15.06 to 16.64 for those taking HDICS.

“No treatment step was clearly associated with improvements in all outcomes. However, omalizumab use was associated with lower risk and improved control,” the researchers wrote. “Practitioners will need to decide with their patients if this is worth the large increase in costs. They will need to balance treatment choice with the patient’s sensitivity to drug and administration costs and insurance coverage.” – by Ryan McDonald

Disclosure: Sullivan reports receiving consulting fees and research grants from Amgen.