The cost of systemic corticosteroid-induced morbidity in severe asthma: a health economic analysis.
The cost of systemic corticosteroid-induced morbidity in severe asthma: a health economic analysis.
复制标题
DOI：
10.1186/s12931-017-0614-x
复制
发表时间：
2017-06-26
影响因子：
5.8
通讯作者：
Heaney LG
中科院分区：
文献类型：
--
作者：
Barry LE;Sweeney J;O'Neill C;Price D;Heaney LG
严重哮喘的治疗可能包括高剂量的全身类固醇治疗，这与大量的额外发病率相关。这项研究通过比较三个患者组（重度哮喘患者、中度哮喘患者和无哮喘患者）来估计与类固醇引起的发病相关的额外医疗费用。重度哮喘患者（n = 808，GINA 步骤 5 治疗）按年龄和性别与轻度/中度哮喘患者（n = 3,975，GINA 步骤 2 和 3 治疗）和非哮喘对照队列（诊断为鼻炎；n = 2,412）进行匹配，这些患者来自最佳患者护理研究数据库 (OPCRD)，这是一个全国代表性的初级保健数据库。处方药和公共资助的医疗保健活动已货币化，并估算了每位患者的年度费用。回归分析用于估计与类固醇引起的发病率相关的额外医疗费用。根据成本计算情况，每人每年的平均医疗费用范围为重度哮喘队列的 2603 - 4533 英镑，轻度/中度哮喘队列的 978 - 2072 英镑，非哮喘控制队列的 560 - 1324 英镑。根据类固醇暴露区分的哮喘患者之间诱发发病成本的差异很明显。就用于治疗类固醇引起的并发症的处方药而言，患有严重哮喘和高类固醇暴露的女性每年比没有哮喘的女性多花费约 789 英镑，而男性比没有哮喘的女性多花费约 744 英镑。估计值外推到所有医疗保健费用。这项研究首次对与类固醇引起的发病率相关的医疗保健额外费用（相对于未接触类固醇的患者）进行了可靠的估计。该研究将有助于为该患者群体使用类固醇节约策略提供信息。本文的在线版本 (doi:10.1186/s12931-017-0614-x) 包含补充材料，可供授权用户使用。
Treatment of severe asthma may include high dose systemic-steroid therapy which is associated with substantial additional morbidity. This study estimates the additional healthcare costs associated with steroid-induced morbidity by comparing three patients groups: those with severe asthma, moderate asthma and no asthma. Patients with severe asthma (n = 808, GINA step 5 treatment) were matched by age and gender with patients with mild/moderate asthma (n = 3,975, GINA step 2 and 3 treatment) and a non-asthma control cohort (with a diagnosis of rhinitis; n = 2,412) from the Optimum Patient Care Research Database (OPCRD), a nationally representative primary care database. Prescribed drugs and publicly funded healthcare activity were monetised and annual costs per patient estimated. Regression analyses were used to estimate the additional healthcare cost associated with steroid-induced morbidity. Average healthcare costs per person per year range from £2603 - £4533 for the severe asthma cohort, to £978 - £2072 for the mild/moderate asthma cohort, to £560 - £1324 for the non-asthma control cohort, depending on the costing scenario. Differences in induced morbidity costs were evident between patients with asthma differentiated by steroid exposure. In relation to prescription drugs used to treat steroid-induced co-morbidities, females with severe asthma and high steroid exposure cost approximately £789 more per year than a corresponding female with no asthma, while males cost approximately £744 more than their counterparts with no asthma. Estimates were extrapolated to all healthcare costs. This study provides the first robust estimates of the additional cost of healthcare related to steroid-induced morbidity relative to patients with no steroid exposure. The study will help inform use of steroid-sparing strategies in this patient group. The online version of this article (doi:10.1186/s12931-017-0614-x) contains supplementary material, which is available to authorized users.