Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Thorax. 2019 Dec;74(12):1113-1119. doi: 10.1136/thoraxjnl-2019-213223. Epub 2019 Sep 18.
The economic impact of multimorbidity in severe or difficult-to-treat asthma has not been comprehensively investigated.
To estimate the incremental healthcare costs of coexisting chronic conditions (comorbidities) in patients with severe asthma, compared with non-severe asthma and no asthma.
Using health administrative data in British Columbia, Canada (1996-2016), we identified, based on the intensity of drug use and occurrence of exacerbations, individuals who experienced severe asthma in an incident year. We also constructed matched cohorts of individuals without an asthma diagnosis and those who had mild/dormant or moderate asthma (non-severe asthma) throughout their follow-up. Health service use records during follow-up were categorised into 16 major disease categories based on the International Classification of Diseases. Incremental costs (in 2016 Canadian Dollars, CAD$1=US$0.75=₤0.56=€0.68) were estimated as the adjusted difference in healthcare costs between individuals with severe asthma compared with those with non-severe asthma and non-asthma.
Relative to no asthma, incremental costs of severe asthma were $2779 per person-year (95% CI 2514 to 3045), with 54% ($1508) being attributed to comorbidities. Relative to non-severe asthma, severe asthma was associated with incremental costs of $1922 per person-year (95% CI 1670 to 2174), with 52% ($1003) being attributed to comorbidities. In both cases, the most costly comorbidity was respiratory conditions other than asthma ($468 (17%) and $451 (23%), respectively).
Comorbidities accounted for more than half of the incremental medical costs in patients with severe asthma. This highlights the importance of considering the burden of multimorbidity in evidence-informed decision making for patients with severe asthma.
严重或难治性哮喘合并多种合并症的经济影响尚未得到全面研究。
评估严重哮喘患者共存慢性疾病（合并症）与非严重哮喘和无哮喘患者相比的增量医疗成本。
我们利用加拿大不列颠哥伦比亚省的健康管理数据（1996-2016 年），根据药物使用强度和哮喘加重发生情况，确定在一个发病年度患有严重哮喘的个体。我们还构建了匹配的无哮喘诊断个体队列，以及整个随访期间患有轻度/休眠性或中度哮喘（非严重哮喘）的个体队列。根据国际疾病分类，将随访期间的健康服务使用记录分类为 16 种主要疾病类别。增量成本（2016 年加拿大元，1CAD=0.75USD=0.56₤=0.68€）估计为严重哮喘患者与非严重哮喘和非哮喘患者相比的医疗保健成本调整差异。
与无哮喘相比，严重哮喘的增量成本为每人每年 2779 加元（95%CI 2514 至 3045），其中 54%（1508 加元）归因于合并症。与非严重哮喘相比，严重哮喘患者的增量成本为每人每年 1922 加元（95%CI 1670 至 2174），其中 52%（1003 加元）归因于合并症。在这两种情况下，最昂贵的合并症是除哮喘以外的呼吸系统疾病（分别为 468（17%）和 451（23%））。
合并症占严重哮喘患者增量医疗费用的一半以上。这凸显了在为严重哮喘患者制定循证决策时，考虑多种合并症负担的重要性。
