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Park JS, Kim B, Kim Y, Lee SG, Kim TH. Out-of-pocket costs associated with chronic respiratory diseases in Korean adults. Chron Respir Dis 2024; 21:14799731241233301. [PMID: 38385436 PMCID: PMC10893827 DOI: 10.1177/14799731241233301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Chronic respiratory diseases (CRDs) are a burden on both individuals and society. While previous literature has highlighted the clinical burden and total costs of care, it has not addressed patients' direct payments. This study aimed to estimate the incremental healthcare costs associated with patients with CRDs, specifically out-of-pocket (OOP) costs. METHODS We used survey data from the 2019 Korea Health Panel Survey to estimate the total OOP costs of CRDs by comparing the annual hospitalizations, outpatient visits, emergency room visits, and medications of patients with and without CRDs. Generalized linear regression models controlled for differences in other characteristics between groups. RESULTS We identified 222 patients with CRDs, of whom 166 were aged 65 years and older. Compared with the non-CRD group, CRD patients spent more on OOP costs (238.3 USD on average). Incremental costs were driven by outpatient visits and medications, which are subject to a coinsurance of 30% or more and may include items not covered by public insurance. Moreover, CRD patients aged 50-64 years incurred the highest incremental costs. DISCUSSION The financial burden associated with CRDs is significant, and outpatient visits and medications constitute the largest components of OOP spending. Policymakers should introduce appropriate strategies to reduce CRD-associated burdens.
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Affiliation(s)
- Jun Su Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Bomgyeol Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yejin Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Theerakittikul T, Nakwan N, Niyompattama A, Siriphan P, Beekman MJHI. Short-acting β 2-agonist prescription patterns in patients with asthma treated by specialists in Thailand: results from SABINA III. J Asthma 2023; 60:2177-2188. [PMID: 37405933 DOI: 10.1080/02770903.2023.2228895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Short-acting β2-agonist (SABA) overuse is associated with poor asthma outcomes; however, the extent of SABA use in Thailand is largely unknown. As part of the SABA use IN Asthma (SABINA) III study, we describe asthma treatment patterns, including SABA prescriptions, in patients treated by specialists in Thailand. METHODS In this observational, cross-sectional study, patients (aged ≥12 years) with an asthma diagnosis were recruited by specialists from three Thai tertiary care centers using purposive sampling. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma [GINA] recommendations). Data on sociodemographics, disease characteristics, and asthma treatment prescriptions were collected from existing medical records by healthcare providers and transcribed onto electronic case report forms. Analyses were descriptive. RESULTS All 385 analyzed patients (mean age: 57.6 years; 69.6% female) were treated by specialists. Almost all (91.2%) patients were classified with moderate-to-severe asthma (GINA treatment steps 3-5), 69.1% were overweight/obese, and 99.7% reported partially/fully reimbursed healthcare. Asthma was partly controlled/uncontrolled in 24.2% of patients; 23.1% experienced ≥1 severe asthma exacerbation in the preceding 12 months. Overall, SABAs were over-prescribed (≥3 canisters/year) in 28.3% of patients. Inhaled corticosteroids (ICS), ICS/long-acting β2-agonists, oral corticosteroid (OCS) burst treatment, and long-term OCS were prescribed to 7.0, 93.2, 19.2, and 6.2% of patients, respectively. Additionally, 4.2% of patients reported purchasing SABA over the counter. CONCLUSIONS Despite receiving specialist treatment, 28.3% of patients were over-prescribed to SABA in the previous 12 months, highlighting a public health concern and the need to align clinical practices with current evidence-based recommendations.
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Affiliation(s)
- Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narongwit Nakwan
- Division of Pulmonology, Department of Medicine, Hat Yai Medical Education Center Hatyai Hospital, Songkhla, Thailand
| | - Anuchit Niyompattama
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Yasaratne D, Idrose NS, Dharmage SC. Asthma in developing countries in the Asia-Pacific Region (APR). Respirology 2023; 28:992-1004. [PMID: 37702387 DOI: 10.1111/resp.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia-Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low-middle-income countries (LMICs) is known to be generally lower compared to high-income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre- and post-natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non-availability and non-affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region-specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC.
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Affiliation(s)
- Duminda Yasaratne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - N Sabrina Idrose
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Alefan Q, Nawasrah A, Almomani B, Al-Issa ET. Direct Medical Cost of Pediatric Asthma in Jordan: A Cost-of-Illness Retrospective Cohort Study. Value Health Reg Issues 2022; 31:10-17. [PMID: 35313157 DOI: 10.1016/j.vhri.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/10/2021] [Accepted: 01/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to estimate and analyze the direct medical costs of pediatric patients with asthma in Jordan from the provider's perspective. METHODS A retrospective analysis of a cohort of pediatric patients with asthma treated during 3 years in a teaching hospital was conducted. The prevalence-based, bottom-up approach has been used to estimate the cost-of-illness of asthma. The total annual direct medical cost was stratified by control status and the severity of asthma. RESULTS The total annual cost for whole the sample (N = 613) in the average of 3 years was Jordanian dinar (JD) 110 874 (US$ 156 382). Pediatrics with uncontrolled asthma had significantly higher annual total direct medical costs than partly controlled and controlled asthma (JD 396 [US$ 558], JD 258 [US$ 364], and JD 150 [US$ 211], respectively) (P < .001). The annual total direct medical cost for severe asthma (JD 455 [US$ 641]) was significantly higher than moderate, mild, and intermittent (JD 176 [US$ 248], JD 35 [US$ 49], and JD 7 [US$ 9.8], respectively) (P < .001). Medications were the most expensive healthcare resource used, accounting for 79.8% of the total cost, followed by outpatient clinic visits and hospitalizations. CONCLUSIONS Healthcare sources utilization and direct medical costs of asthma were highly related to disease severity and control status of the disease. Health policies targeting the achievement of better and stricter asthma control will play a crucial role in the reduction of the economic burden of asthma for society and the patient.
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Affiliation(s)
- Qais Alefan
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Areen Nawasrah
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Basimah Almomani
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman T Al-Issa
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Redmond C, Akinoso-Imran AQ, Heaney LG, Sheikh A, Kee F, Busby J. Socioeconomic disparities in asthma health care utilization, exacerbations, and mortality: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 149:1617-1627. [PMID: 34673047 DOI: 10.1016/j.jaci.2021.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies investigating the effect of socioeconomic status (SES) on asthma health care outcomes have been heterogeneous in the populations studied and methodologies used. OBJECTIVE We sought to systematically synthesize evidence investigating the impact of SES on asthma health care utilization, exacerbations, and mortality. METHODS We searched Embase, Medline, and Web of Science for studies reporting differences in primary care attendance, exacerbations, emergency department attendance, hospitalization, ventilation/intubation, readmission, and asthma mortality by SES. Study quality was assessed using the Newcastle Ottawa Scale, and meta-analyses were conducted using random-effects models. We conducted several prespecified subgroup analyses, including by health care system (insurance based vs universal government funded) and time period (before vs after 2010). RESULTS A total of 61 studies, comprising 1,145,704 patients, were included. Lower SES was consistently associated with increased secondary health care utilization including emergency department attendance (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), hospitalization (OR, 1.63; 95% CI, 1.34-1.99), and readmission (OR, 1.31; 95% CI, 1.19-1.44). Substantial associations were also found between SES and ventilation/intubation (OR, 1.76; 95% CI, 1.13-2.73), although there was no association with primary care attendances (OR, 0.79; 95% CI, 0.51-1.24). We found evidence of borderline significance for increased exacerbations (OR, 1.18; 95% CI, 0.98-1.42) and mortality (OR, 1.12; 95% CI, 0.92-1.37) among more deprived groups. There was no convincing evidence that disparities were associated with country-level health care funding models or that disparities have narrowed over time. CONCLUSIONS Patients with a lower SES have substantially increased secondary care health care utilization. We found evidence suggestive of increased exacerbations and mortality risk, although CIs were wide. These disparities have been consistently reported worldwide, including within countries offering universally funded health care systems. Systematic review registration: CRD42020173544.
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Affiliation(s)
- Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Abdul Qadr Akinoso-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
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Sritart H, Tuntiwong K, Miyazaki H, Taertulakarn S. Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10782. [PMID: 34682527 PMCID: PMC8535297 DOI: 10.3390/ijerph182010782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023]
Abstract
Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.
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Affiliation(s)
- Hiranya Sritart
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| | - Kuson Tuntiwong
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, Tokyo University, Chiba 277-8568, Japan;
| | - Somchat Taertulakarn
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
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Lee E, Kim A, Ye YM, Choi SE, Park HS. Increasing Prevalence and Mortality of Asthma With Age in Korea, 2002-2015: A Nationwide, Population-Based Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:467-484. [PMID: 32141260 PMCID: PMC7061163 DOI: 10.4168/aair.2020.12.3.467] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Purpose The prevalence of asthma is increasing globally as the world population increases; however, and the prevalence and mortality of asthma have not been extensively investigated. Also, the effects of severity and aging on asthma prevalence and mortality are unknown. We aimed to investigate trends of the prevalence and mortality of asthma as well as health care uses and costs over 14 years according to disease severity by using real-world data in Korea. Methods Using the National Health Insurance Sharing Service database, we extracted asthmatic patients having diagnosis codes of asthma and prescription records of antiasthmatic medications from 2002 to 2015 and categorized them according to asthma exacerbation and regular treatment. We defined asthma-associated death in terms of patients' prescription records within 3 months before all-cause death, then linked with the Cause of Death Statistics. The annual asthma-related health care uses and costs were analyzed. Results The prevalence rates of asthma (1.6% to 2.2%) and severe asthma (SA; 3.5% to 6.1% among total asthmatics) have increased steadily over the decade in Korea, where the proportion of elderly asthmatics having increased. The asthma-related health care uses and costs had increased during the study period with the highest uses/costs in SA. The asthma mortality had a steady rising trend from 16.2 to 28.0 deaths per 100,000 with the highest mortality in SA. Conclusions The prevalence and mortality of asthma as well as SA increases along with the burden of health care uses/costs. More active interventions, including changes in health care policies, are needed to reduce the prevalence and mortality of asthma, especially SA.
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Affiliation(s)
- Eunyoung Lee
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea.,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Anhye Kim
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Eun Choi
- College of Pharmacy, Korea University, Sejong, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Flórez-Tanus Á, Parra D, Zakzuk J, Caraballo L, Alvis-Guzmán N. Health care costs and resource utilization for different asthma severity stages in Colombia: a claims data analysis. World Allergy Organ J 2018; 11:26. [PMID: 30459927 PMCID: PMC6231276 DOI: 10.1186/s40413-018-0205-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Asthma is one of the most common chronic respiratory conditions worldwide. Asthma-related economic burden has been reported in Latin America, but knowledge about its economic impact to the Colombian health care system and the influence of disease severity is lacking. This study estimated direct medical costs and health care resource utilization (HCRU) in patients with asthma according to severity in Colombia. METHODS This study identified all-age patients who had at least one medical event linked to an asthma diagnosis (CIE-10: J45-J46) between 2004 and 2014. Patients were selected if they had a continuous enrollment and uninterrupted insurance coverage between January 1-2015 and December 31-2015 and were categorized into 4 different severity levels using a modified algorithm based on Leidy criteria. Healthcare utilization and costs were estimated in a 1-year period after the identification period. A Generalized Linear Model (GLM) with gamma distribution and log link was used to analyze costs adjusting for patient demographics. RESULTS A total of 20,410 patients were included: 69.5% had mild intermittent, 18.0% mild persistent, 6.9% moderate persistent and 5.5% severe persistent asthma; with mean costs (SD) of $67 (134), $482 (1506), $1061 (1983), $2235 (3426) respectively (p < 0.001). The mean total direct cost was estimated at $331 (1278) per patient. Medication and hospitalization had the higher proportion in total costs (46% and 31% respectively). General physician visits was the most used service (57.2%) and short-acting β-2 agonists the most used medication (24%). CONCLUSIONS Health services utilization and direct costs of asthma were highly related to disease severity. Nationwide health policies aimed at the effective control of asthma are necessary and would play an important role in reducing the associated economic impact.
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Affiliation(s)
- Álvaro Flórez-Tanus
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Center for Research and Innovation in Health, Coosalud, Street 11 – 2 Floor 8, Bocagrande, Cartagena, Colombia
| | - Devian Parra
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
| | - Josefina Zakzuk
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cra 5 #7-77, Cartagena, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cra 5 #7-77, Cartagena, Colombia
| | - Nelson Alvis-Guzmán
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Hospital Management and Health Policy Research Group, Universidad de la Costa, Barranquilla, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
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Dilokthornsakul P, Thompson AM, Campbell JD. Treatment patterns and related clinical consequences in adults with asthma. J Asthma 2018; 56:739-747. [PMID: 29972095 DOI: 10.1080/02770903.2018.1490749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE A stepwise therapeutic management is recommended for asthma patients by the Global Initiative for Asthma (GINA). Little is known about the recommendations applied in real world settings. This study aims to associate Treatment step with clinical events in patients with mild or severe asthma. METHODS A retrospective claims database analysis included adult patients with mild (GINA step 1) or severe asthma (GINA step 4). Maximum Treatment Step was measured within the first and second 90-day period after index date (the first date of asthma diagnosis during the inclusion period). Step-down was defined as a Treatment Step change from a higher to lower step, while Step-up was defined as a Treatment Step change from a lower to higher step. The primary outcome was a composite endpoint of asthma-related clinical events, measured at the third 90-day period. RESULTS AND CONCLUSIONS A total of 6,354 mild-asthma patients and 5,695 severe-asthma patients were included. In mild-asthma, when compared with No Change in Treatment Step, Step-down was associated with a lower risk of future clinical events [adjusted odds ratio (OR) 0.80, 95% confidence interval (95% CI); 0.69-0.94], while Step-up was not associated with a change in clinical events [OR 0.98, 95% CI: 0.77-1.27]. In severe-asthma patients, Step-down was not associated with a change in clinical events [OR 0.94, 95% CI: 0.81-1.10], while Step-up was associated with a higher risk of future clinical events [OR 2.07, 95% CI: 1.29-3.33]. Our findings reassure the appropriateness of stepping-down treatment in mild-asthma patients. Clinicians should closely monitor and/or provide detailed asthma action plans for severe-asthma patients who are stepping-up treatment.
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Affiliation(s)
- Piyameth Dilokthornsakul
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences, Naresuan University, Muang , Phitsanulok , Thailand
| | - Angela M Thompson
- b Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
| | - Jonathan D Campbell
- b Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.,c Center for Pharmaceutical Outcomes Research , Skaggs School of Pharmacy and Pharmaceutical Sciences , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA
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10
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Abstract
PURPOSE OF REVIEW The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. RECENT FINDINGS Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. SUMMARY Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.
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Lee YJ, Kwon SH, Hong SH, Nam JH, Song HJ, Lee JS, Lee EK, Shin JY. Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database. Clin Ther 2017; 39:527-536. [PMID: 28196623 DOI: 10.1016/j.clinthera.2017.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Although asthma exacerbation comprises a large burden of the total asthma-related costs, few studies have examined the frequency and cost of acute exacerbation according to asthma severity. This study investigated asthma-related health care utilization and costs according to the severity of asthma. METHODS We conducted a descriptive study using the national health insurance claims database between January 1 and December 31, 2014. We included adult patients with asthma (18 years of age and older) who had ≥2 claims with for an asthma diagnosis and were prescribed ≥1 asthma medications. They were classified into 3 asthma severity levels (level 1 = mild, level 2 = moderate, and level 3 = severe), based on individual medication prescriptions. Acute exacerbation was defined as having a corticosteroid burst, an emergency department visit, or hospitalization. Health care utilization, acute exacerbation, and direct costs associated with asthma were compared according to asthma severity levels. FINDINGS Of the 36,687 adult asthma patients, level 1 had the largest proportion of patients (81.2%), followed by level 2 (18.2%), and level 3 (0.6%). The average number of asthma-related outpatient visits was 4.5 for level 1, 7.2 for level 2, and 11.9 for level 3 (P < 0.01). The estimated asthma-related direct cost per patient was $174 for level 1, $634 for level 2, and $1635 for level 3 (P < 0.01). The number of patients who experienced acute exacerbation increased as asthma severity increased: level 1, 22.6%; level 2, 26.0%; and level 3, 48.7% (P < 0.01). Direct costs associated with asthma exacerbation dramatically increased and accounted for 15.1% of the total cost in level 1 patients, 19.5% in level 2 patients, and 40.8% in level 3 patients (P < 0.01). IMPLICATIONS The direct costs of acute exacerbation increased as asthma severity increased. In patients with severe asthma, acute exacerbation and the relative cost ratio in South Korea were higher than those in other countries. Proper management is required to avoid acute exacerbations and to reduce the burden of asthma, particularly in patients with severe asthma.
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Affiliation(s)
- Yoo Ju Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sung-Hyun Hong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hyun Jin Song
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jong Seop Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
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