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日本重度哮喘患者的真实世界治疗和医疗资源利用情况。

Real-world treatment and health care resource use among severe asthma patients in Japan.

机构信息

Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.

Sanofi K.K., 3-20-2 Nishi Shinjuku, Shinjuku-ku, Tokyo 163-1488, Japan.

出版信息

Respir Investig. 2021 Jul;59(4):464-477. doi: 10.1016/j.resinv.2021.02.010. Epub 2021 Mar 28.

Abstract

BACKGROUND

There are limited studies on healthcare resource use (HCRU) among adult asthma patients in Japan using real-world evidence, and analysis on acute treatment and associated costs stratified by disease severity is further limited. This study aimed to characterize the disease burden of severe asthma patients in Japan in terms of HCRU and comorbid medical conditions, with particular interest in oral corticosteroid (OCS) dependency.

METHODS

This retrospective cohort study of asthma patients used data from a claims database of diagnosis procedure combination hospitals in Japan. The severe asthma cohort included patients treated with OCS for more than 180 days in one year before the index date, with at least one asthma diagnosis claim. Comorbidity and drug use in the look-back period, HCRU, assumed OCS-related adverse events, and asthma exacerbations in the follow-up period were analyzed.

RESULTS

Costs associated with the treatment of severe asthma were approximately twice that of mild/moderate asthma, and the annual median cost of patients hospitalized due to asthma reached ¥448,000 (USD $4073). Annual asthma exacerbation rate was higher in the severe asthma cohort than in the mild/moderate cohort. Patients with longer OCS use in the previous year had higher risks of secondary adrenal insufficiency, osteoporosis, and pneumonia in the following year.

CONCLUSIONS

OCS use among asthma patients in Japan incurred greater medical and economic burden. Better understanding of the disease characteristics including the severity of asthma and appropriate management of disease burden will lead to more optimal use of healthcare resources in Japan.

摘要

背景

利用真实世界证据研究日本成年哮喘患者的医疗资源利用(HCRU)的研究有限,对疾病严重程度分层的急性治疗和相关费用的分析则更为有限。本研究旨在从 HCRU 和合并症的角度描述日本重度哮喘患者的疾病负担,尤其关注口服皮质类固醇(OCS)的依赖性。

方法

这项回顾性队列研究使用了日本诊断程序组合医院的理赔数据库中的哮喘患者数据。重度哮喘队列包括在索引日期前一年内接受 OCS 治疗超过 180 天且至少有一次哮喘诊断的患者。回顾期的合并症和药物使用、HCRU、假设的 OCS 相关不良事件以及随访期的哮喘恶化情况进行了分析。

结果

重度哮喘治疗相关的费用大约是轻度/中度哮喘的两倍,因哮喘住院的患者每年的中位数费用达到 448000 日元(4073 美元)。重度哮喘队列的年度哮喘恶化率高于轻度/中度哮喘队列。前一年 OCS 使用时间较长的患者在次年发生继发性肾上腺功能不全、骨质疏松症和肺炎的风险更高。

结论

日本哮喘患者使用 OCS 会带来更大的医疗和经济负担。更好地了解疾病特征,包括哮喘的严重程度以及适当管理疾病负担,将有助于在日本更优化地使用医疗资源。

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