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. 2017 Jun 26;18(1):129.
doi: 10.1186/s12931-017-0614-x.

The Cost of Systemic Corticosteroid-Induced Morbidity in Severe Asthma: A Health Economic Analysis

Free PMC article

The Cost of Systemic Corticosteroid-Induced Morbidity in Severe Asthma: A Health Economic Analysis

L E Barry et al. Respir Res. .
Free PMC article


Background: Treatment of severe asthma may include high dose systemic-steroid therapy which is associated with substantial additional morbidity. This study estimates the additional healthcare costs associated with steroid-induced morbidity by comparing three patients groups: those with severe asthma, moderate asthma and no asthma.

Methods: Patients with severe asthma (n = 808, GINA step 5 treatment) were matched by age and gender with patients with mild/moderate asthma (n = 3,975, GINA step 2 and 3 treatment) and a non-asthma control cohort (with a diagnosis of rhinitis; n = 2,412) from the Optimum Patient Care Research Database (OPCRD), a nationally representative primary care database. Prescribed drugs and publicly funded healthcare activity were monetised and annual costs per patient estimated. Regression analyses were used to estimate the additional healthcare cost associated with steroid-induced morbidity.

Results: Average healthcare costs per person per year range from £2603 - £4533 for the severe asthma cohort, to £978 - £2072 for the mild/moderate asthma cohort, to £560 - £1324 for the non-asthma control cohort, depending on the costing scenario. Differences in induced morbidity costs were evident between patients with asthma differentiated by steroid exposure. In relation to prescription drugs used to treat steroid-induced co-morbidities, females with severe asthma and high steroid exposure cost approximately £789 more per year than a corresponding female with no asthma, while males cost approximately £744 more than their counterparts with no asthma. Estimates were extrapolated to all healthcare costs.

Conclusions: This study provides the first robust estimates of the additional cost of healthcare related to steroid-induced morbidity relative to patients with no steroid exposure. The study will help inform use of steroid-sparing strategies in this patient group.

Keywords: Asthma; Comorbidity; Health Economics; Systemic Corticosteroids.


Fig. 1
Fig. 1
Mean annual healthcare activity and prescription drugs costs. Mean annual healthcare costs by service group across cohorts (For a full list of activities grouped under each service, see Additional file 1: Table S4), along with asthma related and non-asthma related prescription drug costs. Costs are calculated as the average across High-Low cost scenarios; bar height represents the average of this annual cost per patient per group. ‘Other’ includes physiotherapists, psychiatrists, and opticians, among others and accounted for such a small proportion of total healthcare costs that it cannot be seen on the graph
Fig. 2
Fig. 2
Adjusted differences, between OCS exposure groups, in annual non-asthma prescription costs per patient across age-groups. Difference in annual non-asthma drug cost per patient at each age-group between those with high OCS exposure and those without OCS exposure (red) and between those with low OCS exposure and those without OCS exposure (blue). Differences in costs per patient are adjusted for confounders (sex, region and background morbidity) and calculated holding confounders at the sample mean. Outer lines represent 95% confidence intervals around these estimates

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