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Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain

Valero A1, Molina J2, Nuevo J3, Simon S3, Capel M3, Sicras-Mainar A4, Sicras-Navarro A4, Plaza V5

1Sección de Alergología, Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Spain, Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
2CS Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
3Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
4Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
5Servei de Pneumologia i Al•lèrgia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain

J Investig Allergol Clin Immunol 2022; Vol. 33(2)
doi: 10.18176/jiaci.0767

Objective: To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice.
Methods: A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined.
Results: This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7–29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1−5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year).
Conclusions: SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.

Key words: Short-acting beta-adrenergic agonist, Overuse, Exacerbations, Resource use, Cost