Healthcare Resource Utilization Associated with Intermittent Oral Corticosteroid Prescribing Patterns in Asthma

Abstract

Purpose

Oral corticosteroid (OCS) use for asthma is associated with considerable healthcare resource utilization (HCRU) and costs. However, no study has investigated this in relation to patterns of intermittent OCS prescription.

Methods

This historical UK cohort study used primary care medical records, linked to Hospital Episode Statistics, from 2008 to 2019, of patients (≥4 years old) with asthma prescribed intermittent OCS. Patients were categorized by OCS prescribing pattern (one-off [single], less frequent [≥90-day gap] and frequent [<90-day gap]) and matched 1:1 (by sex, age and index date) with people never prescribed OCS with/without asthma. HCRU (reported as episodes, except for length of hospital stay [days] and any prescription [records]) and associated costs were compared between intermittent OCS and non-OCS cohorts, and among intermittent OCS prescribing patterns.

Results

Of 149,191 eligible patients, 50.3% had one-off, 27.4% less frequent, and 22.3% frequent intermittent OCS prescribing patterns. Annualized non-respiratory HCRU rates were greater in the intermittent OCS versus non-OCS cohorts for GP visits (5.93 vs 4.70 episodes, p < 0.0001), hospital admissions (0.24 vs 0.16 episodes, p < 0.0001), and length of stay (1.87 vs 1.58 days, p < 0.0001). In the intermittent OCS cohort, rates were highest in the frequent prescribing group for GP visits (7.49 episodes; p < 0.0001 vs one-off), length of stay (2.15 days; p < 0.0001) and any prescription including OCS (25.22 prescriptions; p < 0.0001). Mean per-patient non-respiratory related and all-cause HCRU-related costs were higher with intermittent OCS than no OCS (£3902 vs £2722 and £8623 vs £4929, respectively), as were mean annualized costs (£565 vs £313 and £1526 vs £634, respectively). A dose–response relationship existed; HCRU-related costs were highest in the frequent prescribing cohort (p < 0.0001).

Conclusion

Intermittent OCS use and more frequent intermittent OCS prescription patterns were associated with increased HCRU and associated costs. Improved asthma management is needed to reduce reliance on intermittent OCS in primary care.

Keywords:

• asthma
• costs
• healthcare resource utilization
• intermittent
• oral corticosteroids

Abbreviations

BMI, body mass index; BNF, British National Formulary; CPRD, Clinical Practice Research Database; GINA, Global Initiative for Asthma; GP, general practitioner; HCRU, healthcare resource utilization; HES, Hospital Episode Statistics; ICS, inhaled corticosteroids; IQR, interquartile range; NHS, National Health Service; OCS, oral corticosteroids; PSSRU, Personal Social Services Research Unit; SABA, short-acting β₂-agonist; SCS, systemic corticosteroids; SD, standard deviation.

Data Sharing Statement

The dataset supporting the conclusions of this article was derived from the Optimum Patient Care Research Database (www.opcrd.co.uk). The authors do not have permission to give public access to the study dataset; researchers may request access to OPCRD data for their own purposes. Access to OCPRD can be made via the OCPRD website (https://opcrd.co.uk/our-database/data-requests/) or via the enquiries Email [email protected].

Study Ethics

This study was conducted in accordance with the Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) guidelines and was approved by an Independent Scientific Advisory Committee (CPRD approval number ISAC 20_000071). The study is registered with the ENCePP registration number EUPAS37065. No patient-identifying information was accessible during the study.

Acknowledgments

We would like to thank Anna Mett of inScience Communications, Springer Healthcare, UK, for providing medical writing support, which was funded by AstraZeneca.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

CA, HH, JSKC, VC and WH are employees of Observational and Pragmatic Research Institute, Singapore, who conducted this study, funded by AstraZeneca.

WH reports grants from AstraZeneca, during the conduct of the study; grants from Chiesi Pharmaceuticals, outside the submitted work.

VC works for The Optimum Patient Care Global who received funding/grant for the study.

DP has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi Pharmaceuticals, Mylan, Novartis, Regeneron, Sanofi. Thermofisher Scientific and Viatris; consultancy agreements with Airway Vista Secretariat, AstraZeneca, Boehringer Ingelheim, Chiesi Pharmaceuticals, EPG Communication Holdings Ltd, FIECON Ltd, Fieldwork International, GlaxoSmithKline, Medscape, Mylan, Mundipharma, Novartis, OM Pharma SA, PeerVoice, Phadia AB, Spirosure Inc, Strategic North Limited, Synapse Research Management Partners S.L., Talos Health Solutions, Teva Pharmaceuticals, Theravance Biopharma, Viatris and WebMD Global LLC; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi, Theravance, UK National Health Service and Viatris; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Inside Practice, Kyorin, Medscape, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi, Teva Pharmaceuticals and Viatris; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, Teva Pharmaceuticals and Thermofisher; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme and Health Technology Assessment; and was an expert witness for GlaxoSmithKline.

JC, EM, AMG, and TNT are employees of, and own stock in, AstraZeneca.

JH reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Circassia and Teva unrelated to the conduct of the study.

AB has received consultancy fees and speakers’ fees from of AstraZeneca, Amgen, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi and Regeneron, and research grants from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline.

AMG is an employee of, and owns stock in, AstraZeneca and has received grants, advisory board fees, lecture fees and consulting fees from AstraZeneca; advisory board fees from GlaxoSmithKline; advisory board fees and lecture fees from Novartis; advisory board fees, lecture fees and travel expenses from Teva; advisory board fees from Regeneron; and advisory board fees, lecture fees and consulting fees from Sanofi.

DJJ has received consultancy fees and speakers’ fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Sanofi and Regeneron, and research grants from AstraZeneca.

Additional information

Funding

AstraZeneca funded the study. AstraZeneca and OPRI had a role in the study design, data interpretation and writing of the report. OPRI was responsible for the data collection and data analysis. The corresponding author had full access to all the data and had final responsibility to submit for publication.