Unscheduled healthcare resource use among asthma patients receiving low-dose inhaled corticosteroids maintenance treatment

Abstract Background and Aims ANCA associated vasculitis (AAV) treatment aims to quickly control vasculitis activity and then prevent relapse during the maintenance phase of this long term condition. Patients are at risk from disease and treatment related complications with high dose and/or long term glucocorticoid use being a major concern. This retrospective study examined adverse events, infections and healthcare resource use in patients managed in routine practice. Method 1478 AAV patients (France, Germany, Italy, Spain and UK) managed by 493 physicians (61% Nephrologists) who completed induction therapy for new or relapsing organ or life threatening AAV and initiated maintenance therapy between 2014-16 were studied. Data were collected at the time maintenance was determined to begin by the physician and then at 6, 12, 18 and 36 months. 51% had microscopic polyangiitis, mean age 54.2 years with 56% male. BVAS was not used routinely but 56% had moderate systemic disease and 44% severe systemic disease at the time of start of induction remission treatment. Results 78% patients had comorbidity (48% hypertension, 20% dylipidaemia, 17% type 2 diabetes mellitus, 14% depression, 13% COPD/asthma and 9% had BMI > 35) at induction treatment start. Maintenance was defined by physicians as starting approximately 6 months into treatment. AEs potentially linked to GCs were common (values are %, bp = hypertension, DM = diabetes mellitus) during the maintenance phase and many patients remained on long term glucocortioids. Infections were also common, in particular upper (URTI) and lower respiratory tract (LRTI) infection and urinary tract infections (UTI). Hospitilisations still occurred during maintenance period, in particular these are due to infections. Maintenance treatment varied and was changed over follow up (in 13-19% patients at each time point) and in a proportion of patients the change in treatment was precipitated by an adverse event or infection (6 months 21%, 12 months 22%, 18 months 23%, 38 months 26%). Conclusion Comorbidity is common in AAV patients and needs to be considered carefully when making treatment decisions. Patients receiving maintenance therapy frequently experience potentially GC related AEs and infections are also common. Healthcare resource use continues in the maintenance phase and this is on the background of comorbidity, less then complete remission rates and high use of long term steroids. New approaches are required to reduce clinical and healthcare system burdens during the maintenance treatment phase of AAV.

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Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain

Journal of Investigational Allergology and Clinical Immunology ◽

10.18176/jiaci.0767 ◽

2021 ◽

Vol 33 (2) ◽

Author(s):

A Valero ◽

J Molina ◽

J Nuevo ◽

S Simon ◽

M Capel ◽

...

Keyword(s):

Resource Use ◽

Healthcare Costs ◽

Healthcare Resource ◽

National Health System ◽

Asthma Severity ◽

Healthcare Resource Use ◽

Beta Adrenergic ◽

Short Acting ◽

Asthma Patients ◽

The Relationship

Objective: To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice. Methods: A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined. Results: This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7–29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1−5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year). Conclusions: SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.

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Type D personality in Greek employees: Somatization, cardiovascular events and healthcare resource use

PsycEXTRA Dataset ◽

10.1037/e604062012-370 ◽

2012 ◽

Author(s):

Athanasios Lagoudis ◽

Christine Varvara ◽

Panagiotis Stafylas ◽

Stavros Gousopoulos

Keyword(s):

Resource Use ◽

Cardiovascular Events ◽

Healthcare Resource ◽

Type D Personality ◽

Healthcare Resource Use ◽

Type D

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Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049623 ◽

2021 ◽

Vol 11 (4) ◽

pp. e049623

Author(s):

Leona K Shum ◽

Herbert Chan ◽

Shannon Erdelyi ◽

Lulu X Pei ◽

Jeffrey R Brubacher

Keyword(s):

Resource Use ◽

Healthcare Resource ◽

Healthcare Providers ◽

Healthcare Resource Use ◽

Physical And Mental Health ◽

Inception Cohort ◽

Policy Makers ◽

Productivity Costs ◽

Poor Outcome ◽

Lost Productivity

IntroductionRoad trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps.Methods and analysisWe will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs.Ethics and disseminationThe Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.

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