Heffler Enrico, Blasi Francesco, Paggiaro Pierluigi, Canonica Giorgio Walter
Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
Adv Ther. 2025 Feb;42(2):1196-1206. doi: 10.1007/s12325-024-03071-w. Epub 2025 Jan 4.
The burden of severe asthma on patients, especially on those with concomitant chronic rhinosinusitis with nasal polyps (CRSwNP), is substantial. Treatment intensification with oral corticosteroids is a common strategy for managing severe asthma exacerbations; however, prolonged exposure to systemic corticosteroids is associated with multisystem toxicity. This study aimed to quantify the association between oral corticosteroid use and annual asthma-related costs in patients with severe asthma with or without CRSwNP.
This pharmacoeconomic analysis was based on data from the Severe Asthma Network in Italy (SANI) registry. Asthma-related costs were estimated in the context of the Italian healthcare system and included exacerbations requiring treatment intensification, unplanned visits, admissions to hospital and emergency/intensive care units, and lost workdays. For each item, the mean annual cost per patient was estimated based on national tariffs and the frequency of the event. To quantify the association between oral corticosteroid treatment and costs, the study cohort was stratified according to oral corticosteroid use in the 1-year preceding inclusion in the SANI registry.
A total of 669 patients from the SANI registry were included in the present analysis, 255 of whom had concomitant CRSwNP. Corticosteroid use was associated with significantly higher annual disease-related costs per patient compared with no corticosteroid use. Compared with the overall study cohort and patients without CRSwNP, patients with CRSwNP had higher disease-related costs (higher by €1307 and €1869, respectively).
Use of corticosteroids, in particular systemic corticosteroids, is associated with an increase in asthma-related costs. The concomitant presence of CRSwNP impacts negatively on costs. This study suggests that a thorough analysis of costs, expected benefits, and occurrence of adverse events is required when selecting treatment intensification strategies for managing uncontrolled severe asthma.
重度哮喘给患者，尤其是合并慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的患者带来了沉重负担。口服糖皮质激素强化治疗是管理重度哮喘急性加重的常用策略；然而，长期暴露于全身糖皮质激素会导致多系统毒性。本研究旨在量化口服糖皮质激素的使用与有或无CRSwNP的重度哮喘患者年度哮喘相关费用之间的关联。
本药物经济学分析基于意大利重度哮喘网络（SANI）注册研究的数据。在意大利医疗保健系统背景下估算哮喘相关费用，包括需要强化治疗的急性加重、非计划就诊、住院以及急诊/重症监护病房入院和工作日损失。对于每个项目，根据国家收费标准和事件发生频率估算每位患者的年均费用。为了量化口服糖皮质激素治疗与费用之间的关联，根据纳入SANI注册研究前1年的口服糖皮质激素使用情况对研究队列进行分层。
本分析纳入了SANI注册研究中的669例患者，其中255例合并CRSwNP。与未使用糖皮质激素相比，使用糖皮质激素与每位患者更高的年度疾病相关费用显著相关。与整个研究队列和无CRSwNP的患者相比，CRSwNP患者有更高的疾病相关费用（分别高出1307欧元和1869欧元）。
使用糖皮质激素，尤其是全身糖皮质激素，与哮喘相关费用增加有关。CRSwNP的并存对费用产生负面影响。本研究表明，在选择管理未控制的重度哮喘的强化治疗策略时，需要对费用、预期效益和不良事件的发生进行全面分析。
