Study Examines Impact of Biologics for Asthma on HCRU

The benefits of biologics for severe asthma are well known, and seeking to add to that knowledge, a recently published study examined the impact on health care resource utilization (HCRU).

The authors noted that while severe asthma affects a minority of patients, “it increases the burden of asthma and is associated with high humanistic and economic costs.” Patients who do not respond to standard therapies have more frequent exacerbations and airway obstructions. In addition, patients who have severe asthma who have oral corticosteroids (OCS) added to their regiment for more than a year run the risk of infections, bone and muscle disease, atrial fibrillation, and hypertension.

Using a large dataset of health insurance records from Germany, researchers compared HCRU and associated direct and indirect costs before and after starting biologic treatment in patients who were naive to biologics for at least 12 months before the study began.

The real-world, retrospective claims data analysis looked at adult patients with asthma who began a biologic for asthma between January 2015 and June 2018.

Researchers used 2 databases that included insurance data for 7.7 million persons (8% to 9% of the total German population) on inpatient and outpatient care, including diagnoses, procedures, pharmaceutical, and nonpharmaceutical prescriptions and interventions, as well as related costs, from January 2014 to June 2019.

Of the nearly 5 million people continuously enrolled during the timeframe of the study and analyzed, 388,932 patients had a confirmed asthma diagnosis. They were included on the basis of at least 1 inpatient stay or 2 outpatient visits within 365 days or a combination of 2 outpatient visits and at least 1 inpatient stay where asthma was the secondary reason for the hospitalization within 365 days.

The biologics in the database were omalizumab, mepolizumab, benralizumab, and reslizumab (another biologic, dupilumab, was not approved in Germany until 2019).

During the study period, 571 patients with asthma started a biologic (316 on omalizumab, 232 on mepolizumab, 16 on benralizumab, and 7 on reslizumab). The authors noted that the proportion of patients on each product reflects the length of time each drug had been on the market (ie, omalizumab was the first biologic in Germany, in 2005).

At baseline, patients received an average of 2.75 prescriptions for OCS, dropping to an average of 2.17 during the 3.5 year follow-up period.

Hospitalizations and Sick Days

Asthma-related hospitalizations, a proxy of severe exacerbations, saw a significant decrease after starting biologic therapy, falling from 16.99% of patients to 7.18%. Length of hospitalization stays for asthma fell from a mean (SD) 2.06 (7.25) days to 1.15 (6.81).

In addition, after starting a biologic, the proportion of patients hospitalized for any reason also fell significantly, from 42.38% to 31.87%, and the mean number of days spent in the hospital fell significantly, from 6.95 (14.74) to 5.07 (13.92) days per patient.

For sick days, only the asthma-specific leaves outcome by the proportion of patients was statistically significant, with those using at least 1 sick leave day falling from 28.07% to 20.14% (P <.001). However, the average number of sick leave days for any reason was not affected.

Direct and Indirect Costs

After starting a biologic, overall costs rose due to biologic use, but hospitalization costs fell:

• Average total costs per patient were US$7185.16 (€6618.90) during baseline and US$24,785.69 (€22,832.33) during follow-up
• Hospitalization costs dropped significantly, from US$2652.41 (€2443.37) before starting a biologic to US$2108.87 (€1941.93; P < .001)
• Costs per patient during the follow-up period for the biologic were US$17,632.20 (€16,243.20)

The indirect costs of being absent from work also improved significantly.

Among the study’s strengths, the authors cited that the claims data came from different regions in Germany, avoiding bias in patient selection or study site. Due to the nature and structure of the German health care system, the data were also complete.

The study showed that biologic treatment for severe asthma resulted in fewer hospitalizations, reduced OCS prescriptions, and reduced sick leave, all indicating improved asthma control.

“Biologics were linked with higher costs for health care providers in the first year of use,” the authors noted. “Therefore, short- and long-term clinical benefits and financial burden must be considered in the overall context of health care.”

Reference

Hardtstock F, Krieger J, Wilke T, et al. 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. J Asthma Allergy. Published online April 5, 2022. doi:10.2147/JAA.S354062