Use of Biologic Therapies in the Treatment of Asthma – A Comparative Real World Data Analysis on Healthcare Resource Utilization and Costs Before and After Therapy Initiation

Figures & data

Figure 1 Selection of patients with asthma, starting a biologic therapy.

Table 1 Baseline Characteristics of Observed Patients

		Patients with Confirmed Asthma N = 388,932	Asthma Patients Initiating Therapy with Biologics N = 571
Follow-up period in days	Mean (SD) | Median	–	362.89 (23.8) | 365
Index Year (first prescription)
2015	N (%)	–	86 (15.06%)
2016	N (%)	–	158 (27.67%)
2017	N (%)	–	239 (41.86%)
2018	N (%)	–	88 (15.41%)*
Age at index date	Mean (SD)	54.82 (19.56)	54.86 (13.96)
	Median (Min-Max)	56 (18–105)	56 (18–90)
Sex	Female (%) / Male (%)	59.47% / 40.53%	62.70% / 37.30%
All-cause deaths within one year	N (%)	8167 (2.10%)	5 (0.88%)
Urticaria and/or atopic dermatitis (12-month baseline)	N (%)	33,729 (8.67%)	159 (27.85%)
Urticaria (ICD-10 L50)	N (%)	7390 (1.90%)	105 (18.39%)
Atopic dermatitis (ICD-10 L20)	N (%)	27,586 (7.09%)	80 (14.01%)

Notes: For patients with confirmed asthma, the index date was set to 1 July 2018. *The inclusion period ended at June 30, 2018.

Figure 2 Patient sample by index agent and index date (first prescription).

Table 2 Medication Prescriptions During 12-Months Baseline and Follow-Up Period

	Number and Percentage of Patients with at Least One Prescription		Mean (SD)/Median Number of Prescriptions per Patient
Medication	Baseline	Follow-Up	Baseline	Follow-Up
Glucocorticoids (H02AB)	445 (77.93%)	354 (62.00%)	2.84 (2.83)/2	2.26 (2.77) /1
Prednisolone	357 (62.52%)	280 (49.04%)	–	–
Prednisone	72 (12.61%)	46 (8.06%)	–	–
Methylprednisolone	71 (12.43%)	50 (8.76%)	–	–
OCS (H02, oral application only)	437 (76.53%)	346 (60.60%)	2.75 (2.77)/2	2.17 (2.70)/1
LABA+ICS (R03AK)	426 (74.61%)	449 (78.63%)	3.07 (2.95)/3	3.07 (2.87)/3
Salmeterol + fluticasone	159 (27.85%)	149 (26.09%)	–	–
Formoterol + beclomethasone	130 (22.77%)	125 (21.89%)	–	–
Formoterol + budesonide	96 (16.81%)	94 (16.46%)	–	–
Formoterol + fluticasone	80 (14.01%)	78 (13.66%)	–	–
LABA (R03AC)	360 (63.05%)	335 (58.67%)	2.58 (3.75)/1	2.25 (3.67)/1
Salbutamol	298 (52.19%)	366 (64.10%)	–	–
Fenoterol	76 (13.31%)	75 (13.13%)	–	–
Formoterol	62 (10.86%)	47 (8.23%)	–	–
Anticholinergics (R03BB)	301 (52.71%)	299 (52.36%)	1.79 (2.39)/1	1.82 (2.34)/1
Tiotropium bromide	256 (44.83%)	256 (44.83%)	–	–
Ipratropium bromide	55 (9.63%)	30 (5.25%)	–	–
LTRA (R03DC)	226 (39.58%)	191 (33.45%)	0.98 (1.50)/0	0.92 (1.58)/0
Montelukast	226 (39.58%)	191 (33.45%)	–	–
ICS (R03BA)	158 (27.67%)	132 (23.12%)	0.80 (1.85)/0	0.75 (1.99)/0
Budesonide	104 (18.21%)	85 (14.89%)	–	–
Xanthines (R03DA)	98 (17.16%)	85 (14.89%)	0.62 (1.70)/0	0.58 (1.70)/0
Theophylline	96 (16.81%)	84 (14.71%)	–	–
Selective β-agonists (R03CC)	19 (3.33%)	14 (2.45%)	0.08 (0.52)/0	0.08 (0.66)/0
Other drugs for obstructive airway disease (R03DX) (INCLUDING BIOLOGICS)	14 (2.45%)	571 (100%)	0.06 (0.44)/0	6.30 (4.43)/5
TOTAL (any R03- or OCS)	526 (92.12%)	571 (100%)

Table 3 OCS Supply During 12-Months Baseline and Follow-Up Period

		Number of Days with Available Medication Supply
N = 571 Treatment Starter	At Least One Prescription	Baseline		Follow-Up
	N (%)	Mean (SD)	Median	Mean (SD)	Median
Patients who received no OCS during the baseline and the follow-up period	84 (14.71%)	–	–	–	–
Patients who received OCS during the baseline and the follow-up period	295 (51.66%)	–	–	–	–
I.Less or the same medication supply during the follow-up period	186 (32.57%)	332.31 (256.18)	267	167.49 (165.28)	110
II.More medication supply during the follow-up period	109 (19.09%)	188.28 (163.28)	150	364.65 (317.64)	300
Patients who received OCS only during the baseline period	142 (24.87%)	142.53 (139.78)	100	–	–
Patients who received OCS only during the follow-up period	50 (8.71%)	–	–	180.14 (295.73)	100

Table 4 Hospitalizations and Sick Leave Days During Baseline and Follow-Up Period

N = 571 Treatment Starter	12-Month Baseline	12-Month Follow-Up	p-value
Hospitalization stays (total)
N (%) of patients with at least one hospitalization	242 (42.38%)	182 (31.87%)	<0.001
Number of hospitalized days (Mean | SD | Median)	6.95 | 14.74 | 0	5.07 | 13.92 | 0	<0.001
Hospitalization stays with main diagnosis: Respiratory system (ICD-10 J00-J99)
N (%) of patients with at least one hospitalization	152 (26.62%)	75 (13.13%)	<0.001
Number of hospitalized days (Mean | SD | Median)	4.06 | 11.49 | 0	1.90 | 8.34 | 0	<0.001
Hospitalization stays with main diagnosis: Asthma (ICD-10 J45/J46)
N (%) of patients with at least one hospitalization	97 (16.99%)	41 (7.18%)	<0.001
Number of hospitalized days (Mean | SD | Median)	2.06 | 7.25 | 0	1.15 | 6.81 | 0	<0.001
Patients within the working age (defined as age < 64 years)	456	427
Days absent from work (total)
N (%) of patients with at least one sick leave	230 (50.44%)	211 (49.41%)	0.180
Number of sick days of those patients with at least one documented sick leave (Mean | SD | Median)	68 | 112 | 31	54 | 95 | 21	0.123
Days absent from work with main diagnosis: Asthma (ICD-10 J45/J46)
N (%) of patients with at least one sick leave	128 (28.07%)	86 (20.14%)	<0.001
Number of sick days of those patients with at least one documented sick leave (Mean | SD | Median)	73 | 128 | 25	73 | 125 | 22	0.409

Figure 3 All-cause healthcare expenditures per patient during 12-month baseline and follow-up period.