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Economic Consequences of the Overuse of Short-Acting ß-Adrenergic Agonists in the Treatment of Asthma in Spain

Valero A1,2,3, Molina J4, Nuevo J5, Simon S5, Capel M5, Sicras-Mainar A6, Sicras-Navarro A6, Plaza V7,8,9

1Servicio de Alergología, Hospital Clínic de Barcelona, Barcelona, Spain
2Universitat de Barcelona, IDIBAPS, Barcelona, Spain
3CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
4CS Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
5Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
6Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
7Servei de Pneumologia i Al·lèrgia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
8Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
9Universitat Autònoma de Barcelona, Barcelona, Spain

J Investig Allergol Clin Immunol 2023; Vol 33(2) : 109-118
doi: 10.18176/jiaci.0767

Objective: To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice.
Methods: A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined.
Results: The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was €2231, €2345, €2735, €3473, and €4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded a
significant increase in health care costs per patient and year (€5702 vs €1917, P<.001) compared with recommended use (<2 canisters/y).
Conclusion: SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma.

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