Abstract：
BACKGROUND: Despite adherence to inhaled corticosteroid/long-acting β2-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.
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.
摘要：
背景：尽管坚持吸入性皮质类固醇/长效β2激动剂（ICS/LABA）治疗，许多哮喘患者经历中度加重。有关中度恶化对医疗保健系统影响的数据有限。这项研究评估了接受ICS/LABA的患者中度加重的频率和经济负担。
方法：回顾性，纵向研究分析了Optum在2015年10月1日至2019年12月31日期间记录的数据。合格标准包括年龄≥18岁的患者，在12个月的预指数（首次ICS/LABA索赔）中，有≥1项ICS/LABA索赔和≥1项哮喘医疗索赔。主要目标包括描述中度加重频率，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随后严重加重风险之间的关系。在指数后的12个月内，按中度加重频率对患者进行分层。使用新开发的算法确定中度加重。
结果：在指标后的前12个月，61.6%的患者经历了≥1次中度加重。哮喘相关就诊的平均次数为每人每年4.1次，哮喘相关总费用中位数为3544美元。HRU和费用随着加重频率的增加而增加。门诊和住院就诊占这些费用的比例相似。中度加重与未来严重加重的发生率和风险增加相关（发生率比，1.56；危险比，1.51[均p<0.001])。
结论：这项研究强调，尽管接受ICS/LABA治疗，仍有很大比例的患者继续经历中度加重，随后经历经济负担和未来严重加重的风险增加。
方法：回顾性，纵向研究分析了Optum在2015年10月1日至2019年12月31日期间记录的数据。合格标准包括年龄≥18岁的患者，在12个月的预指数（首次ICS/LABA索赔）中，有≥1项ICS/LABA索赔和≥1项哮喘医疗索赔。主要目标包括描述中度加重频率，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随后严重加重风险之间的关系。在指数后的12个月内，按中度加重频率对患者进行分层。使用新开发的算法确定中度加重。
结果：在指标后的前12个月，61.6%的患者经历了≥1次中度加重。哮喘相关就诊的平均次数为每人每年4.1次，哮喘相关总费用中位数为3544美元。HRU和费用随着加重频率的增加而增加。门诊和住院就诊占这些费用的比例相似。中度加重与未来严重加重的发生率和风险增加相关（发生率比，1.56；危险比，1.51[均p<0.001])。
结论：这项研究强调，尽管接受ICS/LABA治疗，仍有很大比例的患者继续经历中度加重，随后经历经济负担和未来严重加重的风险增加。
