1 eMAX Health, White Plains, New York.
2 University of Illinois Hospital and Health Sciences System, Chicago.
J Manag Care Spec Pharm. 2017 Jan;23(1):85-91. doi: 10.18553/jmcp.2017.23.1.85.
The European Respiratory Society and American Thoracic Society (ERS/ATS) published guidelines in 2014 for the evaluation and treatment of asthma. These guidelines draw attention to management of patients with asthma that remains uncontrolled despite therapy. One phenotypic characteristic of therapy-resistant asthma is eosinophil elevation. It is important to better understand the burden of care gaps in this patient subgroup in order to support improved treatment strategies in the future.
To quantify the economic burden of asthma patients with and without peripheral blood eosinophil elevation.
A retrospective cohort study was conducted using data from patients aged 12 years or older with a diagnosis of asthma using electronic health records of over 2 million patients between 2004-2010. Patients with a diagnosis of chronic obstructive pulmonary disease, Churg Strauss syndrome/Wegener's granulomatosis, eosinophilia, cystic/pulmonary fibrosis, allergic bronchopulmonary aspergillosis, or lung cancer in the 12-month period before the date of asthma diagnosis were excluded. Patients with asthma were followed for 12 months after their initial asthma diagnosis to identify those with controlled versus uncontrolled asthma based on ERS/ATS criteria. Patients with at least 1 peripheral blood eosinophil test result of ≥ 400 cells/µL were classified as those with elevated eosinophils. Total annual paid-claim cost was compared by eosinophil levels within the controlled and uncontrolled asthma subgroups. Costs were adjusted to 2015 U.S. dollars. Patients were stratified by control level, and generalized linear modeling regressions were used to assess the magnitude of increase in cost of the elevated eosinophil group.
A total of 2,701 patients were included in the study, of which 17% had uncontrolled asthma and 21% had elevated eosinophils. The mean total annual cost of patients with uncontrolled asthma was more than 2 times the cost of those with controlled asthma ($18,341 vs. $8,670, P < 0.001). Patients with uncontrolled asthma in the elevated eosinophil group had almost double the total cost ($28,644 vs. $14,188, P = 0.008) compared with those with blood eosinophil levels in a normal range. Similarly, patients classified as those with controlled asthma in the elevated eosinophil group had almost twice the average costs as those without elevated eosinophils ($14,754 vs. $7,203, P < 0.001). Uncontrolled asthma with elevated eosinophils had 4 times greater hospital admissions and over 4 times higher total costs than controlled asthma without elevated eosinophils. Among patients with uncontrolled asthma, patients with elevated eosinophils had a 53% increase in mean cost ($17,723 vs. $11,581, P < 0.001) compared with patients without elevated eosinophils. Among patients with controlled asthma, patients with elevated eosinophils had a 62% increase in mean cost ($8,897 vs. $5,486, P < 0.001) compared with patients without elevated eosinophils.
Elevated peripheral blood eosinophil level is associated with higher cost irrespective of disease control status.
This study was funded by Teva Pharmaceuticals. Dotiwala and Casciano report consulting and writing fees from Teva Pharmaceuticals for work on this study. Sun is an employee and stockholder of Teva Pharmaceuticals. Li reports consulting fees from eMAX Health. All authors contributed to study design. Dotiwala took the lead in data collection, along with the other authors, and data interpretation was performed primarily by Krishnan, Sun, and Li, along with Casciano and Dotiwala. The manuscript was written by Casciano, Dotiwala, and Li, along with Sun and Krishnan, and revised by Casciano, Dotiwala, Sun, and Li, with assistance from Krishnan.
欧洲呼吸学会和美国胸科学会（ERS/ATS）于 2014 年发布了哮喘评估和治疗指南。这些指南提请注意尽管接受了治疗，但哮喘仍无法控制的患者的管理问题。治疗抵抗性哮喘的一个表型特征是嗜酸性粒细胞升高。为了支持未来改进治疗策略，重要的是更好地了解这一患者亚组的护理差距负担。
量化伴有和不伴有外周血嗜酸性粒细胞升高的哮喘患者的经济负担。
使用来自 2004 年至 2010 年间 200 多万患者的电子健康记录，进行了一项回顾性队列研究。在哮喘诊断前的 12 个月内诊断患有慢性阻塞性肺疾病、Churg-Strauss 综合征/韦格纳肉芽肿、嗜酸性粒细胞增多症、囊性/肺纤维化、变应性支气管肺曲霉病或肺癌的患者被排除在外。在初始哮喘诊断后 12 个月内，对哮喘患者进行随访，根据 ERS/ATS 标准确定控制与未控制哮喘患者。至少有 1 次外周血嗜酸性粒细胞测试结果≥400 细胞/µL 的患者被归类为嗜酸性粒细胞升高的患者。通过控制和未控制哮喘亚组内的嗜酸性粒细胞水平比较了患者的总年度支付费用。费用调整至 2015 年美元。根据控制水平对患者进行分层，并使用广义线性回归模型评估嗜酸性粒细胞升高组成本增加的幅度。
共有 2701 名患者纳入研究，其中 17%的患者患有未控制的哮喘，21%的患者嗜酸性粒细胞升高。未控制哮喘患者的年平均总成本是控制哮喘患者的两倍多（18341 美元对 8670 美元，P<0.001）。嗜酸性粒细胞升高组未控制哮喘患者的总费用几乎是血液嗜酸性粒细胞水平正常范围患者的两倍（28644 美元对 14188 美元，P=0.008）。同样，在嗜酸性粒细胞升高组被归类为控制哮喘的患者中，其平均费用几乎是没有升高嗜酸性粒细胞患者的两倍（14754 美元对 7203 美元，P<0.001）。伴有嗜酸性粒细胞升高的未控制哮喘患者的住院次数增加了 4 倍，总费用增加了 4 倍以上。在未控制的哮喘患者中，嗜酸性粒细胞升高患者的平均费用增加了 53%（17723 美元对 11581 美元，P<0.001），而没有升高嗜酸性粒细胞的患者则增加了 53%。在控制哮喘患者中，嗜酸性粒细胞升高患者的平均费用增加了 62%（8897 美元对 5486 美元，P<0.001），而没有升高嗜酸性粒细胞的患者则增加了 62%。
无论疾病控制状态如何，外周血嗜酸性粒细胞水平升高与更高的成本相关。
这项研究由梯瓦制药公司资助。Dotiwala 和 Casciano 报告了与梯瓦制药公司就这项研究开展的咨询和写作费用。Sun 是梯瓦制药公司的员工和股东。Li 报告了来自 eMAX Health 的咨询费。所有作者都对研究设计做出了贡献。Dotiwala 与其他作者一起主要负责数据收集，同时主要由 Krishnan、Sun 和 Li 以及 Casciano 和 Dotiwala 进行数据解释。手稿由 Casciano、Dotiwala 和 Li 与 Sun 和 Krishnan 共同撰写，并由 Casciano、Dotiwala、Sun 和 Li 在 Krishnan 的协助下进行修订。
