Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database

Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea

“…27 A descriptive study of asthma-related healthcare utilisation and direct costs in Korea included patients with varying severities of asthma. 12 However, due to its cross-sectional design with 1 year of data, the study population was followed up for less than 1 year, which was not long enough to observe time-dependent relationships between asthma severity and exacerbation or to account for the risk factors of exacerbation. A previous study analysing the risk factors of asthma-related healthcare use found that higher age, being female, chronic asthma, medication compliance and history of exacerbation were independent risk factors for increased asthma-related healthcare use.…”

“…Therefore, in our study, the asthma severity was operationalised on the basis of the definition of severity by the GINA guideline and a previous study that analysed claims data with its definition of asthma severity. 12 Three mutually exclusive severity levels were defined according to patient’s prescribed medication with a primary or secondary diagnosis of asthma during the premeasurement period. Patient was defined as level 3 (severe) if prescribed with an ICS/LABA single inhaler of various intensity (from low dose to high dose) and received at least one prescription of tiotropium or low-dose OCS.…”

“…Based on a previous study, 26 systemic CSs for asthma, asthma-specific hospital admissions and asthma-specific emergency department (ED) visits are recommended core outcomes for classifying asthma exacerbation in observational studies. In order to be distinguished as an exacerbation in adult/adolescent populations, systemic CSs, including high-dose OCS defined as a prednisolone equivalent of ≥30 mg/day in a previous study, 12 should be prescribed for at least 3 days. 26 Therefore, an asthma exacerbation was defined as the occurrence of at least one of three of the following events: CS bursts, hospitalisations or ED visits with asthma as a primary or secondary diagnosis.…”

“… 8–11 However, little is known about differences in the risk factors of exacerbation of asthma with different severities, although a cross-sectional study reported that asthma-related healthcare utilisation and direct costs increased depending on the severity. 12 In addition, while mild asthma is predominant in clinical settings and may be accompanied by chronic conditions, 12 previous studies included cases of severe or persistent asthma, resulting in limited interpretations of these studies. 8 9 13 …”

Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma

“… 24 According to a Korean claims database, the annual healthcare cost for SA patients was $1,635, 9.4 times higher than that for patients with mild asthma ($174), and 40.8% of the healthcare cost was due to asthma exacerbation. 25 The overall asthma-related healthcare cost has increased over years, with the highest cost related to SA. 17 Recurrent exacerbations and uncontrolled asthma are also related to higher asthma-related medical costs.…”