Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Abstract

Background: Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control. Objective: To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma. Design: Asthma patients ≥18 years with ≥1 blood eosinophil count in secondary care (South West Finland) during 2003‒2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil ≤ or >300 cells/μL, using adjusted negative binomial regression models. Results: Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had >300 eosinophil cells/μL blood. Patients with ≤300 and >300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with >300 eosinophil cells/μL blood compared with patients with lower counts. Eosinophil counts >300 cells/μL were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02;1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03;1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87;1.12]). Conclusions: Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts >300 cells/µL, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments.

The burden of adult asthma in Finland: impact of disease severity and eosinophil count on health care resource utilization

“…This likely reflects the high comorbidity burden in patients with severe eosinophilic asthma. These findings are in line with a growing body of literature highlighting the high disease burden and poor prognosis of patients with persistent eosinophilic disease (1,2,16,(19)(20)(21). For example, blood eosinophil counts !300 cells/lL have previously been associated with higher rates of hospital admissions and outpatient visits, compared with blood eosinophil counts <300 cells/lL (16).…”

“…These findings are in line with a growing body of literature highlighting the high disease burden and poor prognosis of patients with persistent eosinophilic disease (1,2,16,(19)(20)(21). For example, blood eosinophil counts !300 cells/lL have previously been associated with higher rates of hospital admissions and outpatient visits, compared with blood eosinophil counts <300 cells/lL (16). We chose the threshold for eosinophil count of !300 cells/lL, in line with previous publications (16,(22)(23)(24)(25) and current treatment guidelines used in clinical practice in Finland.…”

“…For example, blood eosinophil counts !300 cells/lL have previously been associated with higher rates of hospital admissions and outpatient visits, compared with blood eosinophil counts <300 cells/lL (16). We chose the threshold for eosinophil count of !300 cells/lL, in line with previous publications (16,(22)(23)(24)(25) and current treatment guidelines used in clinical practice in Finland. As reported previously and substantiated in this study, this threshold clearly differentiates patients with higher disease burden.…”

“…Moreover, there are variations in calculation of HCRU use and associated costs across studies, with each considering distinct health care categories and taking different cost sources and standard costs into consideration. Nonetheless, the common finding across these studies is a higher use of HCRU and associated costs with severe versus non-severe asthma and/or eosinophilic versus non-eosinophilic asthma (16,19,26,29), highlighting a need for more effective treatments to improve asthma control in this patient subset.…”

“…Those with data available were divided into two groups: <300 cells/lL throughout the follow-up period and !300 cells/lL at any time during the follow-up period. This cutoff was selected as it is supported by current treatment guidelines used in clinical practice in Finland and by a database study in secondary health care in Finland (16). Severe eosinophilic asthma was defined as severe asthma with a blood eosinophil count of !300 cells/lL.…”