German regional variation of acute and high oral corticosteroid use for asthma

Abstract

Objective: 

To improve understanding of real-world asthma treatment and inform physician education, we evaluated regional variation in asthma prevalence and oral corticosteroid (OCS) use across Germany.

Methods: 

We developed a machine learning gradient-boosted tree model with IMS® Disease Analyzer electronic medical records, which cover 3% of German patients. This model had a 91% accuracy in predicting the presence of asthma and chronic obstructive pulmonary disease. We applied the model to the IMS^® Longitudinal Prescription database, with 82% national coverage, to classify patients receiving treatment for airflow obstruction from October 2017–September 2018 in 63 regions in Germany.

Results: 

Of 2.4 million individuals under statutory health insurance predicted to have asthma, 13.7%, 18.7%, 36.5%, 29.4%, and 1.7% received treatment classified as Global Initiative for Asthma (GINA) Steps 1, 2, 3, 4, and 5, respectively. Approximately 7–15% of those at GINA Steps 1–4 and 35% at Step 5 treatment received ≥1 acute OCS prescription (duration <10 days). Of patients receiving GINA Steps 1–4 and Step 5 treatments, 1–3% and 86%, respectively, received ≥1 high-dosage OCS prescription. Cumulative OCS dosage and percentages of patients receiving OCS differed substantially across regions, and regions with lower OCS use had greater use of biologic therapies.

Conclusions: 

Both acute and high OCS use varied regionally across Germany, with overall use suggesting patients are considerable risk of adverse effects and long-term health consequences.

Supplemental data for this article can be accessed at publisher’s website.

Keywords:

• Germany
• bronchial disease
• obstructive lung disease
• medical informatics
• resource allocation

Acknowledgements

This study was funded by AstraZeneca. Editorial support was provided by Nate Connors, PhD, of Citrus Health Group (Lantana, FL, USA), and Michael A. Nissen, ELS, of AstraZeneca (Gaithersburg, MD, USA). Writing support was funded by AstraZeneca.

Declaration of interest

Cassandra Nan is an employee of AstraZeneca and a shareholder of GlaxoSmithKline and AstraZeneca. Olaf Schmidt conducts clinical studies with his Studienzentrum (KPPK Koblenz GmbH) and was a paid consultant and speaker for AstraZeneca, Boehringer Ingelheim, Novartis, Apontis, Berlin-Chemie, Chiesi, Mundipharma and Sanofi-Aventis. Robert Lindner and Yasemin Ilgin are employees of IQVIA. Thomas Schultz conducts clinical studies with his MECS Research GmbH in Berlin, and was a paid consultant and speaker for AstraZeneca, Boehringer Ingelheim, Novartis, Berlin-Chemie, GSK, Mundipharma, Esanum and Sanofi- Aventis. Lykke Hinsch Gylvin is an employee of AstraZeneca. Eugene R. Bleecker has performed clinical trials through his former employer, the Wake Forest School of Medicine, and has served as a paid consultant for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Regeneron, and Sanofi-Aventis.

Data-sharing statement

Data underlying the findings described in this manuscript may be requested in accordance with AstraZeneca’s data-sharing policy described at https://astrazenecagroup-dt.pharmacm.com/DT/Home.