吸入性皮质类固醇/长效β-受体激动剂治疗的哮喘患者病情加重的频率和经济负担：一项回顾性美国索赔研究
2024/04/24
摘要
背景：尽管坚持吸入皮质激素/长效β2-受体激动剂（ICS/LABA）治疗，许多哮喘患者仍会出现中度病情加重。有关中度加重对医疗系统影响的数据十分有限。本研究评估了接受 ICS/LABA 治疗的患者中度病情加重的频率和经济负担。
方法： 回顾性纵向研究分析了Optum的去标识化Clinformatics Data Mart数据库中2015年10月1日至2019年12月31日期间记录的数据。资格标准包括年龄≥18岁的患者，在索引前的12个月内（首次 ICS/LABA 索赔），其 ICS/LABA 索赔次数≥1次，且哮喘医疗索赔次数≥1次。首要目标包括描述哮喘中度加重的频率以及相关的医疗资源利用率（HRU）和成本。次要目标是评估中度加重与后续严重加重风险之间的关系。根据指数发布后12个月内的中度恶化频率对患者进行分层。使用新开发的算法识别中度恶化。
结果 在指数发布后的头12个月中，61.6% 的患者经历了≥1次中度恶化。哮喘相关就诊的平均次数为每人每年4.1次，哮喘相关总费用的中位数为3544美元。HRU和费用随着病情加重频率的增加而增加。门诊和住院就诊在这些费用中所占比例相似。中度恶化与未来严重恶化的发生率和风险增加有关（发生率比为1.56；危险比为1.51[均为 p<0.001]）。
结论： 本研究强调，尽管接受了 ICS/LABA 治疗，但仍有很高比例的患者会继续出现中度病情加重，从而增加经济负担和未来出现严重病情加重的风险。
Frequency and economic burden of exacerbations in inhaled corticosteroid/long-acting beta-agonist-treated patients with asthma: a retrospective US claims study
M. Sheng Duh, M. H. Roberts, K. J. Rothnie, W. Y. Cheng, P. Thompson-Leduc, S. Zhang, et al.
Abstract
BACKGRUND:Despite adherence to inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) therapy, many patients with asthma experience moderate exacerbations. Data on the impact of moderate exacerbations on the healthcare system are limited. This study assessed the frequency and economic burden of moderate exacerbations in patients receiving ICS/LABA.
METHODS: Retrospective, longitudinal study analyzed data from Optum's de-identified Clinformatics Data Mart Database recorded between October 1, 2015, and December 31, 2019. Eligibility criteria included patients ≥18 years of age with ≥1 ICS/LABA claim and ≥1 medical claim for asthma in the 12 months pre-index (first ICS/LABA claim). Primary objectives included describing moderate exacerbation frequency, and associated healthcare resource utilization (HRU) and costs. A secondary objective was assessing the relationship between moderate exacerbations and subsequent risk of severe exacerbations. Patients were stratified by moderate exacerbation frequency in the 12 months post index. Moderate exacerbations were identified using a newly developed algorithm.
RESULTS: In the first 12 months post index 61.6% of patients experienced ≥1 moderate exacerbation. Mean number of asthma-related visits was 4.1 per person/year and median total asthma-related costs was $3544. HRU and costs increased with increasing exacerbation frequency. Outpatient and inpatient visits accounted for a similar proportion of these costs. Moderate exacerbations were associated with an increased rate and risk of future severe exacerbations (incidence rate ratio, 1.56; hazard ratio, 1.51 [both p<0.001]).
CONCLUSIONS: This study highlighted that a high proportion of patients continue to experience moderate exacerbations despite ICS/LABA therapy and subsequently experience increased economic burden and risk of future severe exacerbations.
背景：尽管坚持吸入皮质激素/长效β2-受体激动剂（ICS/LABA）治疗，许多哮喘患者仍会出现中度病情加重。有关中度加重对医疗系统影响的数据十分有限。本研究评估了接受 ICS/LABA 治疗的患者中度病情加重的频率和经济负担。
方法： 回顾性纵向研究分析了Optum的去标识化Clinformatics Data Mart数据库中2015年10月1日至2019年12月31日期间记录的数据。资格标准包括年龄≥18岁的患者，在索引前的12个月内（首次 ICS/LABA 索赔），其 ICS/LABA 索赔次数≥1次，且哮喘医疗索赔次数≥1次。首要目标包括描述哮喘中度加重的频率以及相关的医疗资源利用率（HRU）和成本。次要目标是评估中度加重与后续严重加重风险之间的关系。根据指数发布后12个月内的中度恶化频率对患者进行分层。使用新开发的算法识别中度恶化。
结果 在指数发布后的头12个月中，61.6% 的患者经历了≥1次中度恶化。哮喘相关就诊的平均次数为每人每年4.1次，哮喘相关总费用的中位数为3544美元。HRU和费用随着病情加重频率的增加而增加。门诊和住院就诊在这些费用中所占比例相似。中度恶化与未来严重恶化的发生率和风险增加有关（发生率比为1.56；危险比为1.51[均为 p<0.001]）。
结论： 本研究强调，尽管接受了 ICS/LABA 治疗，但仍有很高比例的患者会继续出现中度病情加重，从而增加经济负担和未来出现严重病情加重的风险。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Respiratory medicine, 2024, 226: 107629-107629 DOI: 10.1016/j.rmed.2024.107629）
（Respiratory medicine, 2024, 226: 107629-107629 DOI: 10.1016/j.rmed.2024.107629）
Frequency and economic burden of exacerbations in inhaled corticosteroid/long-acting beta-agonist-treated patients with asthma: a retrospective US claims study
M. Sheng Duh, M. H. Roberts, K. J. Rothnie, W. Y. Cheng, P. Thompson-Leduc, S. Zhang, et al.
Abstract
BACKGRUND:Despite adherence to inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) therapy, many patients with asthma experience moderate exacerbations. Data on the impact of moderate exacerbations on the healthcare system are limited. This study assessed the frequency and economic burden of moderate exacerbations in patients receiving ICS/LABA.
METHODS: Retrospective, longitudinal study analyzed data from Optum's de-identified Clinformatics Data Mart Database recorded between October 1, 2015, and December 31, 2019. Eligibility criteria included patients ≥18 years of age with ≥1 ICS/LABA claim and ≥1 medical claim for asthma in the 12 months pre-index (first ICS/LABA claim). Primary objectives included describing moderate exacerbation frequency, and associated healthcare resource utilization (HRU) and costs. A secondary objective was assessing the relationship between moderate exacerbations and subsequent risk of severe exacerbations. Patients were stratified by moderate exacerbation frequency in the 12 months post index. Moderate exacerbations were identified using a newly developed algorithm.
RESULTS: In the first 12 months post index 61.6% of patients experienced ≥1 moderate exacerbation. Mean number of asthma-related visits was 4.1 per person/year and median total asthma-related costs was $3544. HRU and costs increased with increasing exacerbation frequency. Outpatient and inpatient visits accounted for a similar proportion of these costs. Moderate exacerbations were associated with an increased rate and risk of future severe exacerbations (incidence rate ratio, 1.56; hazard ratio, 1.51 [both p<0.001]).
CONCLUSIONS: This study highlighted that a high proportion of patients continue to experience moderate exacerbations despite ICS/LABA therapy and subsequently experience increased economic burden and risk of future severe exacerbations.
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