Health care resource use and costs associated with possible side effects of high oral corticosteroid use in asthma: a claims-based analysis

Figures & data

Figure 1 Study timeline.

Figure 2 Study cohort selection.

Abbreviations: IV, intravenous; OCS, oral corticosteroid.

Table 1 High OCS use: patient demographics and comorbidity

Characteristic	Without possible side effects, n=593	With possible side effects, n=3,011	P-value
Mean (SD) age (years)	45.8 (12.2)	56.0 (12.1)	<0.001a,b
95% CI	44.8–46.8	55.6–56.5
Age (years), n (%)			<0.001a,c
18–34	105 (17.7)	134 (4.5)
35–44	162 (27.3)	343 (11.4)
45–54	189 (31.9)	828 (27.5)
55–64	106 (17.9)	1,091 (36.2)
≥65	31 (5.2)	615 (20.4)
Female, n (%)	392 (66.1)	2,061 (68.4)	0.263a,c
Region, n (%)			0.320a,c
Midwest	160 (27.0)	772 (25.6)
Northeast	72 (12.1)	366 (12.2)
South	259 (43.7)	1,425 (47.3)
West	102 (17.2)	448 (14.9)
Mean (SD) Charlson	1.8 (1.4)	3.4 (2.7)	<0.001a,b
Comorbidity Index score
95% CI	1.6–1.9	3.3–3.5
COPD, n (%)	115 (19.4)	1,503 (49.9)	<0.001a,c

Notes:

a Comparison between groups without versus with possible side effects among high OCS users.

b two-sample Student’s t-test.

c chi-square-test.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; OCS, oral corticosteroid; SD, standard deviation.

Table 2 Unadjusted annualized all-cause and asthma-related health care resource use for high OCS use patients, stratified by possible side effect group

Mean (SD) health care resource	Without possible side effects, n=593	With possible side effects, n=3,011	P-valuea
All-cause
Number of office visits	17.6 (14.7)	23.4 (15.5)	<0.001b
95% CI	16.4–8.8	22.9–24.0
Number of inpatient hospitalizations/year	0.19 (0.49)	0.60 (0.94)	<0.001c
95% CI	0.15–0.23	0.56–0.63
Number of emergency department visits/year	0.84 (3.24)	0.78 (2.90)	0.698c
95% CI	0.58–1.10	0.67–0.88
Asthma-relatedd
Number of office visits	3.3 (4.6)	3.1 (5.0)	0.384b
95% CI	2.9–3.7	2.9–3.3
Number of inpatient hospitalizations/year	0.04 (0.17)	0.11 (0.36)	<0.001c
95% CI	0.03–0.06	0.10–0.12
Number of emergency department visits/year	0.06 (0.64)	0.03 (0.36)	0.051c
95% CI	0.01–0.11	0.02–0.05

Notes:

a Comparison between groups without versus with possible side effect among high OCS users.

b two-sample Student’s t-test.

c Wilcoxon rank-sum test.

d Claims with primary diagnosis of asthma.

Abbreviations: CI, confidence interval; OCS, oral corticosteroid; SD, standard deviation.

Table 3 High OCS use patients with and without possible side effects: adjusteda annualized health care resource use

Adjusted meana (SE) health care resource	Without possible side effects, n=593	With possible side effects, n=3,011	P-valueb
All-cause
Number of office visits	19.6 (0.6)	23.0 (0.3)	<0.001
95% CI	18.3–20.9	22.5–23.6
Number of inpatient hospitalizations/year	0.22 (0.02)	0.44 (0.01)	<0.001
95% CI	0.18–0.27	0.41–0.46
Number of emergency department visits/year	0.66 (0.10)	0.73 (0.04)	0.549
95% CI	0.50–0.88	0.64–0.82
Asthma-related
Number of asthma-related office visits	2.9 (0.2)	3.2 (0.1)	0.205
95% CI	2.5–3.3	3.0–3.4
Number of asthma-related inpatient hospitalizations/year	0.03 (0.007)	0.07 (0.006)	<0.001
95% CI	0.02–0.05	0.06–0.09
Number of asthma-related emergency department visits/year	0.01 (0.005)	0.02 (0.003)	0.451
95% CI	0.01–0.03	0.01–0.02

Notes:

a Adjusted by age group in years, sex, region, Charlson Comorbidity Index score, and chronic obstructive pulmonary disease status.

b Comparison between groups without versus with possible side effects.

Abbreviations: CI, confidence interval; OCS, oral corticosteroid; SE, standard error.

Table 4 High OCS use patients (n=3,604) with or without possible side effects: mean total unadjusted annualized health care costsa estimated for individual possible side effect

Potential side effect of interest	Total costs			Total prescription costs			Total nonprescription costs
	Without possible side effect of interest	With possible side effect of interest	P-valuea	Without possible side effect of interest	With possible side effect of interest	P-valuea	Without possible side effect of interest	With possible side effect of interest	P-valuea
Hypertension
n	1,336	2,268		1,336	2,268		1,336	2,268
Mean (SD)	$18,095 ($20,326)	$28,475 ($32,621)	<0.001	$7,215 ($8,968)	$10,255 ($10,935)	<0.001	$10,880 ($15,820)	$18,220 ($27,708)	<0.001
95% CI	$17,004–$19,186	$27,131–$29,818		$6,733–$7,696	$9,805–$10,705		$10,031–$11,730	$17,079–$19,361
Diabetes
n	2,377	1,277		2,377	1,277		2,377	1,277
Mean (SD)	$21,727 ($27,189)	$30,244 ($31,795)	<0.001	$8,323 ($9,970)	$10,687 ($10,895)	<0.001	$13,404 ($22,649)	$19,558 ($26,645)	<0.001
95% CI	$20,634–$22,821	$28,463–$32,025		$7,922–$8,724	$10,076–$11,297		$12,493–$14,315	$18,065–$21,050
Lipid disorder
n	1,616	1,988		1,616	1,988		1,616	1,988
Mean (SD)	$22,456 ($30,917)	$26,392 ($27,448)	<0.001	$8,015 ($9,975)	$10,033 ($10,568)	<0.001	$14,441 ($25,912)	$16,359 ($22,791)	0.020
95% CI	$20,947–$23,964	$25,185–$27,599		$7,528–$8,502	$9,568–$10,497		$13,177–$15,705	$15,357–$17,362
Pneumonia
n	2,582	1,022		2,582	1,022		2,582	1,022
Mean (SD)	$21,431 ($25,496)	$32,702 ($35,459)	<0.001	$8,354 ($9,402)	$11,083 ($12,226)	<0.001	$13,077 ($21,494)	$21,619 ($29,258)	<0.001
95% CI	$20,447–$22,415	$30,526–$34,879		$7,991–$8,717	$10,333–$11,834		$12,247–$13,906	$19,823–$23,415

Note:

a Comparison between groups without potential side effects versus with potential side effects; two-sample Student’s t-test. Values shown in US dollars.

Abbreviations: CI, confidence interval; OCS, oral corticosteroid; SD, standard deviation.