[en] BACKGROUND: Patients with severe asthma (SA) consume roughly 50% of the global asthma healthcare resources due to unscheduled visits, hospitalisations, therapy and management of oral corticosteroid (OCS)-related adverse events (AEs). Biologics offer a route away from continuous OCS treatment. Asthma management guidelines discourage OCS usage, particularly when continuous and at high doses because of increased risk of OCS-AEs. This study simulates the economic burden over 10 years of reversible OCS-AEs (hypertension, psychiatric conditions, sleep disorders, dyspepsia) in SA patients in 11 European countries. METHODS: The focus of this study was exclusively on the economic burden of AEs resulting from continuous OCS use in SA patients. For each country, a budget impact model estimated total AE costs in SA patients in various OCS sparing scenarios. AE costs arising from daily OCS use (reference cost) were compared to AE costs when a percentage of patients annually stops OCS, and the rate of OCS-related AEs decreases. Epidemiological data, OCS-AE prevalence values and costs were literature-based. RESULTS: Analysis showed potential cost reductions of 13.1% to 31.6% in terms of OCS-related comorbidities over 10 years among SA patients. The size of the saving depends on the rate of onset of comorbidity, the reversibility of OCS comorbidities and the proportion of the population stopping OCS each year. CONCLUSION: Stopping OCS has the potential to yield substantial, long-term AE savings in SA patients.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Mascialino, Barbara ; GSK, Verona, Italy.
Bansal, Aruna T; Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK.
Bel, Elisabeth; Department of Pulmonology, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
Canonica GW, Colombo GL, Bruno GM, et al. SANI Network. Shadow cost of oral corticosteroids-related adverse events: a pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12: 100007.
Lang DM. Severe asthma: epidemiology, burden of illness, and heterogeneity. Allergy Asthma Proc 2015; 36: 418–424.
Hekking PW, Wener RR, Amelink M, et al. The prevalence of severe refractory asthma. J Allergy Clin Immunol 2015; 135: 896–902.
Larsson K, Ställberg B, Lisspers K, et al. Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR). Respir Res 2018; 19: 12.
von Bülow A, Kriegbaum M, Backer V, et al. The prevalence of severe asthma and low asthma control among Danish adults. J Allergy Clin Immunol Pract 2014; 2: 759–767.
Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma. Eur Respir J 2014; 43: 343–373.
Accordini S, Corsico AG, Braggion M, et al. The cost of persistent asthma in Europe: an international population-based study in adults. Int Arch Allergy Immunol 2013; 160: 93–101.
Antonicelli L, Bucca C, Neri M, et al. Asthma severity and medical resource utilisation. Eur Respir J 2004; 23: 723–729.
Godard P, Chanez P, Siraudin L, et al. Costs of asthma are correlated with severity: a 1-yr prospective study. Eur Respir J 2002; 19: 61–67.
O’Neill S, Sweeney J, Patterson CC, et al. The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry. Thorax 2015; 70: 376–378.
Sadatsafavi M, Lynd L, Marra C, et al. Direct health care costs associated with asthma in British Columbia. Can Respir J 2010; 17: 74–80.
Lefebvre P, Duh MS, Lafeuille M-H, et al. Acute and chronic systemic corticosteroid-related complications in patients with severe asthma. J Allergy Clin Immunol 2015; 136: 1488–1495.
Walsh LJ, Wong CA, Oborne J, et al. Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax 2001; 56: 279–284.
Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy 2018; 11: 193–204.
Sweeney J, Patterson CC, Menzies-Gow A, et al. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax 2016; 71: 339–346.
Foster JM, McDonald VM, Guo M, et al. “I have lost in every facet of my life”: the hidden burden of severe asthma. Eur Respir J 2017; 50: 1700765.
Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017; 357: j1415.
Bel EH, Wenzel SE, Thompson PJ, et al. Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. N Engl J Med 2014; 371: 1189–1197.
Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med 2017; 376: 2448–2458.
Rabe KF, Nair P, Brusselle G, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med 2018; 378: 2475–2485.
World Population Review. Total Population by Country 2025. Date last accessed: 31 March 2025. https://worldpopulationreview.com/countries/
Kroes JA, Bansal AT, Berret E, et al. Blueprint for harmonising unstandardised disease registries to allow federated data analysis: prepare for the future. ERJ Open Res 2022; 8: 00168-2022.
Pesce G, Locatelli F, Cerveri I, et al. Correction: seventy years of asthma in Italy: age, period and cohort effects on incidence and remission of self-reported asthma from 1940 to 2010. PLoS ONE 2018; 13: e0191589.
Vlayen J, De Backer G, Peers J, et al. Atherosclerotic cardiovascular diseases in Belgium: a cost-of-illness analysis. Cardiovasc Drugs Ther 2008; 22: 487–494.
Gustavsson A, Svensson M, Jacobi F, et al.; CDBE2010Study Group. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21: 718–779.
Spanggaard M, Bogelund M, Dirksen C, et al. The substantial costs to society associated with obesity: a Danish register-based study based on 2002–2018 data. Expert Rev Pharmacoecon Outcomes Res 2022; 22: 823–833.
Bruley des Varannes S, Grandstedt Lofman H, Karlsson M, et al. Cost and burden of gastroesophageal reflux disease among patients with persistent symptoms despite proton pump inhibitor therapy: an observational study in France. BMC Gastroenterol 2013; 13: 39.
Tibi-Levy Y, de Pouvourville G, Westerloppe J, et al. The cost of treating high blood pressure in general practice in France. Eur J Health Econ 2008; 9: 229–236.
National Health Insurance Fund (NEAK). Date last accessed: 31 March 2025. https://www.neak.gov.hu/preview/felso_menu/rolunk/koszonto/koszonto
Gazso T, Boncz I, Sebestyen A, et al. Health insurance cost of hypertensive heart disease in Hungary: a nationwide cost of illness study. Val Health 2018; 21: S102.
d’Errico M, Pavlova M, Spandonaro F. The economic burden of obesity in Italy: a cost-of-illness study. Eur J Health Econ 2022; 23: 177–192.
Wansen LAW, Knauff EAH, Tan SS, et al. Estimated hospital health costs of chronic abdominal pain in the Netherlands. Neth J Med 2014; 72: 102–106.
Kok L, Engelfriet P, Jacobs-van der Bruggen MAM, et al. The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands. Eur J Cardiovasc Prev Rehabil 2009; 16: 371–376.
Kwrzysztoszek J, Koligat D, Ratajczak P, et al. Economic aspects of hypertension treatment in Poland. Arch Med Sci 2014; 10: 607–617.
Beresniak A, Malfertheiner P, Franceschi F, et al. Helicobacter pylori “Test-and-Treat” strategy with urea breath test: a cost-effective strategy for the management of dyspepsia and the prevention of ulcer and gastric cancer in Spain – results of the Hp-Breath initiative. Helicobacter 2020; 25: e12693.
Scholze J, Alegria E, Ferri C, et al. Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy: a prevalence-based model. BMC Public Health 2010; 10: 529.
Pares-Badell O, Barbaglia G, Jerinic P, et al. Cost of disorders of the brain in Spain. PLoS ONE 2014; 9: e105471.
Johannesson M, Borgquist L, Jönsson B. The costs of treating hypertension in Sweden. An empirical investigation in primary health care. Scand J Prim Health Care 1991; 9: 155–160.
Soubieres A, Wilson P, Poullis A, et al. Burden of irritable bowel syndrome in an increasingly cost-aware National Health Service. Frontline Gastroenterol 2015; 6: 246–251.
Gov.uk. New figures show high blood pressure costs NHS billions each year. Date last accessed: 31 March 2025. www.gov.uk
Frix AN, Heaney LG, Dahlen B, et al. Heterogeneity in the use of biologics for severe asthma in Europe: a SHARP ERS study. ERJ Open Res 2022; 8: 00273-2022.
Barry LE, Sweeney J, O’Neill C, et al. The cost of systemic corticosteroid-induced morbidity in severe asthma: a health economic analysis. Respir Res 2017; 18: 129.
Hawcutt DB, Francis B, Carr DF, et al. Susceptibility to corticosteroid-induced adrenal suppression: a genome-wide association study. Lancet Respir Med 2018; 6: 442–450.
Tran TN, Healtley H, Rowell J, et al. Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom. J Allergy Clin Immunol Glob 2024; 3: 100225.
