(203) Healthcare Resource Utilisation Associated with Intermittent Oral Corticosteroid Use in Asthma

Publication Number: 877

Background: Oral corticosteroids (OCS) are widely prescribed for asthma exacerbations but little is known about the healthcare burden of intermittent OCS use.

Objectives: To assess the association between different patterns of intermittent OCS use and healthcare resource utilisation (HCRU) and cost in asthma.

Methods: Historical cohort study of UK patients ≥4 years old using the Clinical Practice Research Datalink, linked to Hospital Episode Statistics (2008–2019). Patients receiving intermittent OCS were categorised by OCS prescribing pattern based on prescription gaps (only 1 [once-only], >1 with any gaps >90-days but no gaps < 90-days [less frequent] and >1 with < 90-day gap(s) [frequent]) and indexed on the first intermittent OCS prescription within 3 months of an asthma-related event; OCS-naïve patients with asthma matched on gender, age and index date served as controls. Follow-up was until end-of-records. Patients with a diagnosis for a chronic condition treated with OCS or a chronic adverse event outcome pre-index were excluded. HCRU (general practitioner [GP], Accident and Emergency [A&E] and outpatient visits, hospitalisations and prescriptions) and cost were compared for OCS and non-OCS use (Mann-Whitney test) and for intermittent OCS use patterns (Chi-squared test). Cost sources were Personal Social Services Research Unit 2020 for GP and outpatient visits and hospitalisations; NHS National Cost Collection 2019/20 for A&E visits; Prescription Cost Analysis 2018 for prescriptions.

Results: Of 763,136 patients with asthma receiving an OCS prescription, 149,191 met eligibility criteria (52.6% female, mean age 38.7 years). 50.3%, 27.4% and 22.3% had once-only, less frequent and frequent pattern of OCS use during follow-up, respectively; 149,191 OCS-naïve patients were included. Frequency of respiratory-related GP, A&E and outpatient visits, hospitalisations and prescriptions post-index were higher in OCS versus OCS-naïve patients (Mean 9.0 vs 3.8, 1.8 vs 1.4, 5.2 vs 4.1, 2.0 vs 1.6 and 37.1 vs 13.9; all p< 0.0001), and increased with more frequent patterns of intermittent OCS use (p < 0.0001). Similar results were observed for average cost/patient for all visit types post-index (OCS vs OCS-naïve: £354.09 vs £148.34, £322.90 vs £249.78, £698.41 vs £548.53, £6,791.66 vs £5,423.71 and £421.15 vs £131.44); total average cost was £10,329.16 (OCS) vs £5,215.87 (non-OCS; p< 0.0001).

Conclusions: In patients with asthma, intermittent OCS use was associated with increased HCRU and associated costs versus non-OCS use. More frequent patterns of OCS use were associated with a higher burden on healthcare resources. All efforts should be made to reduce the need for intermittent OCS use in asthma management.