Lifetime Health Care Costs Associated with Systemic Corticosteroid Use in Adults with Persistent Asthma Interview with:
Yen Chung, PharmD

Payer Evidence Director
US Medical Affairs, AstraZeneca What is the background for this study?

Response: Among patients with persistent asthma, use of systemic corticosteroids (SCS) is typically reserved for treatment of asthma exacerbations and as a supplemental maintenance therapy for patients whose disease remains uncontrolled with maximum maintenance controller therapies. However, SCS therapy comes with known risks for acute and chronic complications. It is well established that patients with severe asthma are responsible for a disproportionate amount of the economic burden of asthma;  however, less clear is the extent to which systemic corticosteroids use and its consequences specifically contributes to the cost burden of asthma.

The purpose of this study was to use administrative claims to follow asthma patients with and without SCS treatment for up to 3 years and compare their complication rates, health care resource utilization, and costs. What are the main findings?

Response: Patients with persistent asthma showed that systemic corticosteroids-related adverse complications and health care costs were significantly higher in the 3 years after initial systemic corticosteroids exposure, irrespective of subsequent SCS exposure. Chronic systemic corticosteroids complication-related, asthma-related, and all-cause direct health care costs were higher among systemic corticosteroids users than matched controls users at all time points evaluated, and the difference in cost was greatest among those patients who received 4+ SCS treatments in the first year. What should readers take away from your report?

Response:  This study highlights the clinical and economic cost and consequences of systemic corticosteroids use in persistent asthma, and raises awareness of the potential benefits of minimizing systemic corticosteroids use in the treatment of persistent asthma whenever possible.  Even a few courses of oral corticosteroids annually put patients at risk of steroid-related adverse outcomes.  Therapeutic options to minimize the reliance on corticosteroids in asthma patients should be maximized by healthcare providers. What recommendations do you have for future research as a result of this study?

Response: Future research should examine outcomes over a longer follow-up period; it may take years for some complications to develop, particularly when SCS treatment is started at a younger age. Additionally, future studies should aim to examine the relationship between changes in systemic corticosteroids dosing over time as it relates to outcomes, and also replicate analyses in electronic medical record data if possible, where the clinical depth is greater than available in claims.

This study was funded by AstraZeneca.



Lifetime Health Care Costs Associated with Systemic Corticosteroid Use in Adults with Persistent Asthma

Nicole Zimmerman, Yen Chung, James Kreindler, Joseph Tkacz, MS


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Last Updated on May 1, 2020 by Marie Benz MD FAAD