The burden of severe asthma in France: a case-control study using a medical claims database

Publication date: Available online 25 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Arnaud Bourdin, Caroline Fabry-Vendrand, Juliette Ostinelli, Malik Ait-Yahia, Elsa Darnal, Stéphane Bouee, Caroline Laurendeau, Isabelle Bureau, Julie Gourmelen, Christos Chouaid

Abstract

Background

Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long term outcomes and costs of SA.

Objective

To provide accurate information on SA, focussing on comorbidities, mortality, health care resource consumption and associated costs.

Methods

A cohort of SA patients identified in 2012 was extracted from a French representative claims database and followed for three years. Their characteristics, comorbidities, mortality and direct costs were compared with a matched control group without asthma.

Results

690 SA patients were matched to 2070 patients without asthma (mean age 61 years, 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population.

Comorbidities were more frequent in SA patients (73.9% suffered from cardiovascular disease vs. 54.3% in controls, p<0.001). 58.7% of SA patients used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 box/year/patient and 9% received ≥6 dispensings of OCS. 6.7% were treated by omalizumab. SA patients were more frequently hospitalised (33.2% vs 19.7%, p<0.001), more frequently consulted a general practitioner (GP) (97.8% vs 83.9%, p<0.001) (9.8±6.8 vs 6.2±5.3 consultations/year, p<0.001) and 31% have consulted a private respiratory physician.

Compared to controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%, p=0.007). Direct medical cost was $9,227 vs. $3,950 (p<0.001) mostly driven by medication costs.

Conclusion

The prevalence of SA in the French adult population is at least 18/10,000. Burden of disease is high with respect to comorbidities, mortality and asthma-related healthcare resource use.

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