Healthcare costs associated with short-acting β2-agonists in asthma: observational UK SABINA study

Darush Attar-Zadeh; Toby Capstick; Deborah Leese; Sofie Arnetorp; Eleni Rapsomaniki; Keith Peres Da Costa; Ekaterina Maslova; Yang Xu; Danny Gibson; Jennifer K Quint

doi:10.3399/BJGPO.2023.0015

Healthcare costs associated with short-acting β₂-agonists in asthma: observational UK SABINA study

BJGP Open. 2023 Sep 19;7(3):BJGPO.2023.0015. doi: 10.3399/BJGPO.2023.0015. Print 2023 Sep.

Authors

Affiliations

¹ North West London Children & Young People Asthma Network, London, UK darushattar@hotmail.com.
² Medicines Management and Pharmacy Services, Leeds Teaching Hospital NHS Trust, Leeds, UK.
³ Sheffield Medicines Optimisation Team, NHS Sheffield Clinical Commissioning Group, Sheffield, UK.
⁴ Biopharmaceuticals Business Unit, Global Market Access Pricing, Vaccine & Immune Therapy, AstraZeneca, Gothenburg, Sweden.
⁵ Real World Science, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
⁶ AI R&D Department, ZS Associates, London, UK.
⁷ BioPharmaceutical Medical, Medical Affairs Respiratory and Immunology, AstraZeneca, Cambridge, UK.
⁸ Global Market Access and Pricing, Health Economics and Payer Evidence, AstraZeneca, Cambridge, UK.
⁹ National Heart Lung Institute, Imperial College London, London, UK.

Abstract

Background: Poor asthma control is associated with high short-acting β₂-agonist (SABA) use.

Aim: To assess asthma-related healthcare resource utilisation (HCRU) and medication costs associated with high versus low SABA prescriptions in the UK.

Design & setting: Analysis of SABINA I (SABA use IN Asthma I), a retrospective longitudinal study using UK electronic health records (Clinical Practice Research Datalink GOLD 2008-2019 and Hospital Episode Statistics database).

Method: Eligible patients were ≥12 years old with SABA prescriptions in the past year. SABA prescriptions (number of canisters per year) were defined as high (≥3) or low (1-2). Association of SABA prescriptions with HCRU was assessed by negative binominal model adjusted for covariates. The UK unit costs from the NHS were applied to estimate total healthcare costs (2020). Medication costs were based on the annual average number of canisters per year per patient.

Results: Overall, 186 061 patients with SABA prescriptions were included, of whom 51% were prescribed high SABA. Total annual average costs (HCRU and medication) were 52% higher in the high SABA group versus the low SABA group (£2 256 091 per 1000 patients/year versus £1 480 640 per 1000 patients/year). Medication costs accounted for the majority of asthma-related costs. Across both groups, most HCRU costs were for non-exacerbation-related primary care or hospital outpatient visits. The annual average HCRU cost difference for high SABA versus low SABA was the greatest for hospitalisations (+230%; £15 521 per 1000 patients/year versus £4697 per 1000 patients/year) and exacerbation-related primary care visits (+162%; £18 770 per 1000 patients/year versus £7160 per 1000 patients/year). Asthma-related HCRU extrapolated to the broader UK asthma population was £108.5 million per year higher with high SABA versus low SABA.

Conclusion: High SABA versus low SABA prescriptions are associated with higher asthma-related HCRU costs.

Keywords: asthma; emergency treatment; health care costs; prescriptions; United Kingdom; adrenergic beta-2 receptor agonist; primary health care.