Considerable health burden for patients with poorly controlled asthma
medwireNews: Study findings show a high prevalence of poorly controlled asthma among patients treated with inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combination therapy, highlighting poor treatment adherence or an unmet need in current treatment.
The findings, based on data from the 2011–2013 US National Health and Wellness Survey, are particularly pertinent given that the research also showed that low levels of asthma control were associated with worse health-related quality of life (HRQoL), greater loss of work productivity, impaired activity, greater healthcare use, and higher costs.
Among 1923 patients with asthma and at least one allergy-related comorbid condition, over half, at 54.4%, had very poorly controlled (29.3%) or not well-controlled (25.1%) asthma, based on Asthma Control Test scores of 15 points or below and 16–19 points, respectively.
“The substantial number of uncontrolled asthma patients demonstrates the importance of appropriate disease monitoring by the treating clinician, including assessment of treatment adherence and consideration for stepping up therapy,” say Lulu Lee (Kantar Health, Foster City, California, USA) and colleagues.
All the asthma patients had an increased health and economic burden compared with population norms. Those with very poorly controlled asthma, particularly, had a significantly greater burden after adjusting for covariates, including age, gender, ethnicity, body mass index, alcohol intake, exercise, and years of diagnosed asthma.
These patients had an average mental health component summary score of 41.8, compared with 45.2 and 48.8 for patients with not well-controlled and well-controlled asthma, respectively, a significant difference (p<0.001). And their risk for any anxiety disorder, depression, and sleep problems was increased 1.8 times, 1.9 times, and 1.7 times, respectively.
Similarly, significant differences (all p<0.001) were seen for the average physical health component summary score, at a corresponding 35.7 versus 43.0 and 46.7, and for all eight health domains surveyed, with patient with very poorly controlled asthma scoring more than 8 points lower on role-physical and nearly 8 points lower on social functioning , compared with other patients.
These differences contributed to significantly lower work productivity, and greater activity impairment and greater healthcare resource use, with annual direct healthcare costs incurred by patient with very poorly controlled asthma 1.5-fold higher than those for well-controlled patients, while indirect costs were 2.2-fold higher. The annual total costs incurred were 1.5-fold higher.
“Overall, the current study highlights a considerable unmet need in asthma patients on ICS and LABA and should help inform both healthcare practitioner and payor understanding and decision-making with regard to alleviating disease burden,” say Lee and colleagues in the Journal of Asthma.
They recommend appropriate disease monitoring by treating clinicians, including assessment of treatment adherence, and consideration for stepping up therapy in accordance with current guidelines, including increasing the dose of ICS and using additional treatments such as biologics and oral corticosteroids as needed.
“Even a modest increment in asthma control was associated with less work productivity loss, [healthcare utilization], and costs,” they stress.
By Lucy Piper
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