title: Utilization and Costs of Severe Uncontrolled Asthma in a Managed-Care Setting.
abstract: BACKGROUND
  Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation.
  
  
  OBJECTIVE
  The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting.
  
  
  METHODS
  This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression.
  
  
  RESULTS
  Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959).
  
  
  CONCLUSIONS
  Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly, personalized treatment approaches including novel biologic treatments.
authors.affiliation: Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.affiliation: Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.affiliation: GlaxoSmithKline, Research Triangle Park, NC.
authors.forename: Anand A
authors.initials: AA
authors.lastname: Dalal
authors.affiliation: Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
authors.forename: Lei
authors.initials: L
authors.lastname: Qian
authors.affiliation: Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
authors.forename: Wansu
authors.initials: W
authors.lastname: Chen
authors.affiliation: Kaiser Permanente Northern California Region, Oakland, Calif.
authors.forename: Eunice W
authors.initials: EW
authors.lastname: Ngor
authors.affiliation: GlaxoSmithKline, Research Triangle Park, NC.
authors.forename: Robert Y
authors.initials: RY
authors.lastname: Suruki
authors.affiliation: Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
authors.forename: Aniket A
authors.initials: AA
authors.lastname: Kawatkar
mesh_terms: D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D018450:Disease Progression; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008329:Managed Care Programs; D012008:Recurrence; D014481:United States; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists
keywords: Antiasthma agents; Asthma control; Asthma cost; Asthma guidelines; Asthma impairment; Asthma risk; Controller medication; Persistent asthma; Severe asthma