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Severe asthma and exacerbations
S64 The Cost of Refractory Asthma in the UK - a Preliminary Analysis
  1. S O'Neill1,
  2. J Sweeney2,
  3. C O Neill3,
  4. C Brightling4,
  5. A Menzies-Gow5,
  6. R Niven6,
  7. R Chaudrai7,
  8. C Bucknall8,
  9. A Mansur9,
  10. C Patterson10 LG Heaney on behalf of the British Thoracic Society Difficult Asthma Network11
  1. 1National University of Ireland, Galway
  2. 2Centre for Infection Immunity, Queens University of Belfast
  3. 3National University of Ireland, Galway
  4. 4Institute for Lung Health, University of Leicester, Department of Infection, Inflammation Immunity, Leicester
  5. 5Royal BromptonHarefield NHS Foundation Trust, London
  6. 6The University of Manchester (MAHSC)University Hospital of South Manchester, Manchester
  7. 7Gartnavel General Hospital, Glasgow
  8. 8Glasgow Royal Infirmary, Glasgow
  9. 9Heart of England NHS Foundation Trust, Birmingham
  10. 10Centre for Public Health, Queens University of Belfast
  11. 11Centre for Infection Immunity, Queens University of Belfast.


Introduction Refractory asthma poses a potentially significant burden in terms of healthcare costs. Relatively little is known about the cost of treatment or what factors explain variations in treatment costs. This study uses data from the British Thoracic Society (BTS) Difficult Asthma Registry to estimate the healthcare costs associated with a sample of well-characterised refractory asthmatics and examines the role of a range of factors in explaining variations in healthcare.

Methods In this analysis data were extracted from the Registry on 689 patients and examined healthcare utilisation including all prescribed medicines, hospital inpatient stays, ITU stays, A&E/GP visits and CT scans over a 12 month period prior to the patient first being assessed at the specialist clinics. Patient characteristics included age, gender, lung function, clinical centre were care was provided, adherence status, BMI and whether or not the patient was on maintenance oral steroids. Unit costs were based on standard published sources. Costs were examined by category with respect to patient characteristics and total cost with respect to patient characteristics in multivariate regression analyses.

Results Mean total treatment cost among refractory asthmatics ranged between £3,402 (SD=2,680) to £4,234 (SD=£3,036). In a comparator non-refractory group mean total cost ranged from £1,944 (SD= £1,728) and £2,565 (£2,065). Drug costs comprised approximately 58% of all costs in refractory asthmatics and approximately 55% in the non-refractory group. In the refractory group significant predictors of total costs were FEV1, clinical centre in which care was provided, maintenance oral steroids and BMI. Patients who were on maintenance steroids cost 48% more than those who were not. Patients who were morbidly obese cost approximately 23% more than those who were normal weight.

Conclusion Treating individuals with refractory asthma presents a significant cost to the health service. The role of maintenance steroids in cost is dramatic and may relate to the impact of steroid induced morbidity and warrants further investigation.

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