Assessing asthma severity based on claims data: a systematic review

Jacob, Christian; Haas, Jennifer S.; Bechtel, Benno; Kardos, Péter; Braun, Sebastian

doi:10.1007/s10198-016-0769-2

Cited by 38 publications

(33 citation statements)

References 55 publications

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“…The algorithm has been developed using Canadian administrative databases and has been validated against the Canadian consensus guidelines for the definition of asthma severity. In general, this definition is concordant with the definition proposed by the joint European Respiratory Society/American Thoracic Society Task Force on severe asthma [22], is similar to other claims-based definitions [23], and has been used in multiple previous studies [24][25][26]. In summary, healthcare records in a patient-year were considered as being compatible with severe asthma based on a combination of high doses of inhaled corticosteroid dispensed (defined as >1,000μg prednisone-equivalent), frequent filled prescriptions of inhaled short-acting beta agonists (SABA), the filled prescriptions of other controller therapies, and markers of exacerbations such as emergency department visits and hospital admissions.…”

Section: Assessing Asthma Severitysupporting

confidence: 77%

Trends in oral corticosteroids use in severe asthma: a 14-year population-based study from Canada

Sadatsafavi

Khakban

Tavakoli

et al. 2020

Preprint

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Abstract Background: Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort.Methods: We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression.Results: 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p<0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p<0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis.Conclusions: This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.

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Section: Assessing Asthma Severitysupporting

confidence: 77%

Trends in oral corticosteroids use in severe asthma: a 14-year population-based study from Canada

Sadatsafavi

Khakban

Tavakoli

et al. 2020

Preprint

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“…Asthma severity classification was mainly based on Leidy criteria [ 32 , 33 ]. This algorithm has been used previously in other administrative claims studies [ 34 – 36 ] and is based on the number of β2-agonist inhalers and oral corticosteroid (OCS) fills used during the year of cost analysis.…”

Section: Methodsmentioning

confidence: 99%

Health care costs and resource utilization for different asthma severity stages in Colombia: a claims data analysis

Flórez-Tanus

Parra

Zakzuk

et al. 2018

World Allergy Organization Journal

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BackgroundAsthma is one of the most common chronic respiratory conditions worldwide. Asthma-related economic burden has been reported in Latin America, but knowledge about its economic impact to the Colombian health care system and the influence of disease severity is lacking. This study estimated direct medical costs and health care resource utilization (HCRU) in patients with asthma according to severity in Colombia.MethodsThis study identified all-age patients who had at least one medical event linked to an asthma diagnosis (CIE-10: J45-J46) between 2004 and 2014. Patients were selected if they had a continuous enrollment and uninterrupted insurance coverage between January 1–2015 and December 31–2015 and were categorized into 4 different severity levels using a modified algorithm based on Leidy criteria. Healthcare utilization and costs were estimated in a 1-year period after the identification period. A Generalized Linear Model (GLM) with gamma distribution and log link was used to analyze costs adjusting for patient demographics.ResultsA total of 20,410 patients were included: 69.5% had mild intermittent, 18.0% mild persistent, 6.9% moderate persistent and 5.5% severe persistent asthma; with mean costs (SD) of $67 (134), $482 (1506), $1061 (1983), $2235 (3426) respectively (p < 0.001). The mean total direct cost was estimated at $331 (1278) per patient. Medication and hospitalization had the higher proportion in total costs (46% and 31% respectively). General physician visits was the most used service (57.2%) and short-acting β-2 agonists the most used medication (24%).ConclusionsHealth services utilization and direct costs of asthma were highly related to disease severity. Nationwide health policies aimed at the effective control of asthma are necessary and would play an important role in reducing the associated economic impact.Electronic supplementary materialThe online version of this article (10.1186/s40413-018-0205-4) contains supplementary material, which is available to authorized users.

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“…Included patients were also required to have evidence of an asthma diagnosis as indicated by meeting at least one of the following criteria in the baseline period or on the index date: 1) at least one inpatient claim or one emergency department (ED) claim with a primary diagnosis for asthma (ICD-9-CM code 493.0x, 493.1x, or 493.9x) as specified in the Healthcare Effectiveness Data and Information Set (HEDIS) claims-based definition for persistent asthma. 19 Given the potential for misclassification using the HEDIS criteria, asthma was also identified in patients with; 2) two or more other (i.e., non-ED) outpatient medical claims with an asthma diagnosis or; 3) at least one inpatient or outpatient medical claim with an asthma diagnosis along with at least one outpatient prescription claim for an asthma medication, including immunomodulators, inhaled corticosteroids (ICS), long-acting beta agonists (LABAs), ICS/LABA combinations, leukotriene modulators, mast cell stabilizers, short-acting beta agonists (SABAs), or xanthines.…”

Section: Methodsmentioning

confidence: 99%

The effect of DPP-4 inhibitors on asthma control: an administrative database study to evaluate a potential pathophysiological relationship

Colice

Price

Verdier

et al. 2017

POR

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RationaleDPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control.MethodsThis was a retrospective, observational, matched cohort study using administrative claims in the MarketScan® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases. Adult asthma patients initiating an oral DPP-4i or a non-DPP-4i between November 1, 2006 and March 31, 2014 were included. Patients were followed for asthma-related outcomes for 12 months after initiation of the antidiabetes medication. Outcomes included risk-domain asthma control (RDAC), defined as no asthma hospitalizations, no lower respiratory tract infections, and no oral corticosteroid (OCS) prescriptions; overall asthma control (RDAC criteria plus limited short-acting beta agonist use); treatment stability (RDAC criteria plus no increase of ≥50% in inhaled corticosteroid dose or addition of other asthma therapy); and severe asthma exacerbation rates (asthma-related hospitalizations, emergency room visits, or acute treatments with OCS). Comparisons were made between two matched cohorts (DPP-4i vs. non-DPP-4i initiators) using multivariable logistic regression and generalized linear modeling. Covariates included baseline demographic and clinical characteristics related to asthma and T2DM.ResultsThe adjusted odds of achieving RDAC (odds ratio [OR]: 1.05; 95% CI: 0.964 to 1.147), overall asthma control (OR: 1.04; 95% CI: 0.956 to 1.135), and treatment stability (OR: 1.04; 95% CI: 0.949 to 1.115) did not differ between the DPP-4i and non-DPP-4i cohorts. A difference was not found between cohorts in severe asthma exacerbation rates during the 12 months following initiation of antidiabetes treatment (mean = 0.32 vs. 0.34 exacerbations per subject-year, respectively; p=0.064).ConclusionAsthma control was similar between patients initiating DPP-4i and non-DPP-4i antidiabetes medications, suggesting no association between DPP-4i use and asthma control.

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Assessing asthma severity based on claims data: a systematic review

Cited by 38 publications

References 55 publications

Trends in oral corticosteroids use in severe asthma: a 14-year population-based study from Canada

Trends in oral corticosteroids use in severe asthma: a 14-year population-based study from Canada

Health care costs and resource utilization for different asthma severity stages in Colombia: a claims data analysis

The effect of DPP-4 inhibitors on asthma control: an administrative database study to evaluate a potential pathophysiological relationship

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