Corticosteroids Create Challenges in Severe Asthma Treatment

Corticosteroid healthcare costs and side effects should be weighed prior to selecting treatment strategies for patients with severe asthma, according to a new pharmacoeconomic analysis.

"Systemic steroids cause substantial morbidity, which requires treatment and can cause significant quality of life impairment, so the economic equation is important," said principle investigator Liam Heaney, MD (pictured), professor of respiratory medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, UK, in an interview with MD Magazine.

"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," Heaney and colleagues wrote.

Led by Heaney, researchers compared matched patients, grouped by levels of exposure to systemic steroids due to having severe, moderate, or no asthma. They acknowledged that different healthcare expenditures could reflect differences in condition and severity, rather than remediation of corticosteroid-related morbidities.

To "disentangle" the expenditures, however, they applied several algorithms to distinguish non-asthma related costs. In addition to the presence or absence of corticosteroid treated asthma, the groups were stratified for such possible steroid-related morbidities as osteopenia and glaucoma.

Heaney and colleagues found a statistically significantly higher number of comorbidities as corticosteroid exposure increased. Costs also increased with higher corticosteroid exposure, and the non-asthma drug costs accounted for an increasingly greater proportion as healthcare costs increased. When analysis controlled for several potential confounders, females were found to have incurred greater healthcare costs than males, and younger patients tended to have greater costs than older patients.

The researchers determined that average annual healthcare costs per person with severe asthma, expressed in British pounds, ranged from £2,603 to £4,533, from £978 to £2,072 for those with mild/moderate asthma, and from £560 to £1,324 for the non-asthma cohort. Analysis of costs for corticosteroid-induced co-morbidities indicated that females would incur an additional £789 per year and males an additional £744. The additional annual non-asthma drug costs, attributed to treatment of co-morbidities, was estimated to average approximately £112 for those with moderate exposure to corticosteroids and £772 for those with high exposure.

"The potential savings associated with corticosteroid-induced morbidity which would be avoided through use of effective corticosteroid-sparing treatments should be incorporated in models which estimate the cost-effectiveness of such therapies," the researchers recommended.

Patient data were drawn from a large patient care research database in the UK for the period from 2008 to 2013, with 808 patients identified with severe asthma, 3,975 with mild to moderate asthma, and 2,412 with rhinitis as the non-asthma control. The researchers established costs of prescribed drugs and the annual cost of publicly funded healthcare. Healthcare costs attributed to steroid-induced morbidity were estimated with regression analyses.

The cost analysis of corticosteroid-related morbidity in severe asthma was published June 26 online in Respiratory Research.