Characterization and burden of severe eosinophilic asthma in New Zealand: Results from the HealthStat Database

Abstract

Background: This retrospective cohort study aimed to characterize epidemiology, medication use and healthcare resource utilization (HCRU) of patients diagnosed with severe eosinophilic asthma (SEA) compared to other patients with asthma in New Zealand.
Methods: Adult patients with asthma with no concurrent diagnosis of Chronic Obstructive Lung Disease (COPD) were identified from the HealthStat primary care database and the National Minimum Dataset using asthma diagnosis, hospital codes and prescriptions. Patients with SEA were identified using a 1-year baseline period (2011) and were those with: inhaled corticosteroid prescription above medium dose (including high dose) plus controller medication, ≥2 exacerbations, and eosinophils ≥300 cells/µl (or ≥150 in 6 weeks prior to index date); patients were followed for 1 year (2012).
Results: 160/3276 (4.9%) asthmatics with available eosinophil counts met SEA criteria. Patients with SEA were more likely to be Māori, former smokers, have more comorbidities, higher mean BMI and higher neutrophil counts compared with other patients with asthma. In the follow-up period, SEA patients had over 4 times as many exacerbations; incidence of exacerbations of the same frequency were highest in Māori patients.
Conclusions: Compared with other patients with asthma, SEA patients had over 1.5 times as many respiratory treatment prescriptions and higher all-cause HCRU and total healthcare costs; asthma-related healthcare costs were 3.6 times greater.

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Author Biographies

Sumitra Shantakumar, Epidemiology and Health Economics, GlaxoSmithKline

Dr. Sumitra Shantakumar (Epidemiology and Health Economics Head, GlaxoSmithKline - Greater China and Intercontinental Region) performs a cross-therapeutic role focused on the delivery of population-based disease epidemiology and burden evidence to inform late-stage clinical development programs, and medicines approaching registration, launch, reimbursement and lifecycle management. In addition to real-world evidence generation, Dr Shantakumar is actively engaged in advancing GSK’s access to high quality observational databases in Asia-Pacific through external engagement at the regional and local levels. Prior to her relocation to Singapore, Dr Shantakumar led the global epidemiology strategy for the anti-angiogenesis cancer therapy pazopanib, across multiple tumor types, and from early through late development stages.  Dr Shantakumar received her doctoral degree in Epidemiology from the Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, where she holds an adjunct appointment and was co-president of the UNC Epidemiology Alumni Association.  She also holds an adjunct appointment with the Center of Quantitative Medicine at Duke-NUS. She earned her master’s degree in Epidemiology from Boston University School of Public Health, and bachelor of science in Biology from UNC Chapel Hill.

Yu-Fan Ho, Epidemiology and Health Economics, GlaxoSmithKline

Mr. Yu-Fan Ho  is the Regional Health Outcomes Manager for GlaxoSmithKline under Department of Epidemoilogy and Health Economics for the Greater China and Intercontinental Region

Janine Beale, Medical Affairs, GlaxoSmithKline, Auckland

Dr. Janine Beale was the Respiratory Medical Affairs Manager within GlaxoSmithKline, Auckland - New Zealand at the time of study conduct. Her background is in immunology and respiratory research having undertaken a PhD at Imperial College London investigating the role of IL-25 in rhinovirus-induced asthma exacerbations funded by the National Health and Lung Institute.

Barry Gribben, CBG Health Research, Auckland

Dr. Barry Gribben (Director - Public Sector Surveying, CBH Health Research, Auckland, New Zealand) has been involved with primary health care and research for over 20 years. He was a south Auckland GP working in a busy multi-cultural practice for 15 years and Director of the RNZCGP Research Unit in Auckland University for 5 years. His research interests are in new methods for analysing large datasets and multilevel modelling in the health sector.

References

Green RH, Brightling CE, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet 2002;360:1715-21. DOI: https://doi.org/10.1016/S0140-6736(02)11679-5

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. DOI: https://doi.org/10.1183/09031936.00202013

Calhoun WJ, Haselkorn T, Mink DR, et al. Clinical burden and predictors of asthma exacerbations in patients on guideline-based steps 4-6 asthma therapy in the TENOR cohort. J Allergy Clin Immunol Pract 2014;2:193-200. DOI: https://doi.org/10.1016/j.jaip.2013.11.013

Serra-Batlles J, Plaza V, Morejon E, et al. Costs of asthma according to the degree of severity. Eur Respir J 1998;12:1322-6. DOI: https://doi.org/10.1183/09031936.98.12061322

Dean BB, Calimlim BC, Sacco P, et al. Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional Internet-based survey. Health Qual Life Outcomes 2010;8:96. DOI: https://doi.org/10.1186/1477-7525-8-96

Fleming L, Murray C, Bansal AT, et al. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts. Eur Respir J 2015;46:1322. DOI: https://doi.org/10.1183/13993003.00780-2015

Shaw DE, Sousa AR, Fowler SJ, et al. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort. Eur Respir J 2015;46:1308-1321. DOI: https://doi.org/10.1183/13993003.00779-2015

Bahadori K, Doyle-Waters MM, Marra C, et al. Economic burden of asthma: a systematic review. BMC Pulm Med 2009;9:24-24. DOI: https://doi.org/10.1186/1471-2466-9-24

Barnard L, Baker M, Pierse N, et al. The impact of respiratory disease in New Zealand: 2014 update. 2015. Last accessed: February 2019. Available from: www.asthmafoundation.org.nz/research/the-impact-of-respiratory-disease-in-new-zealand-2014-update

Lai CK, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009;64:476-83. DOI: https://doi.org/10.1136/thx.2008.106609

Crane J, Lewis S, Slater T, et al. The self reported prevalence of asthma symptoms amongst adult New Zealanders. N Z Med J 1994;107:417-21.

Ellison-Loschmann L, Pattemore PK, Asher MI, et al. Ethnic differences in time trends in asthma prevalence in New Zealand: ISAAC Phases I and III. Int J Tuberc Lung Dis 2009;13:775-82.

Pattemore PK, Ellison-Loschmann L, Asher MI, et al. Asthma prevalence in European, Maori, and Pacific children in New Zealand: ISAAC study. Pediatr Pulmonol 2004;37:433-42. DOI: https://doi.org/10.1002/ppul.10449

Gillies TD, Tomlin AM, Dovey SM, et al. Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases. Prim Care Respir J 2013;22:312-8. DOI: https://doi.org/10.4104/pcrj.2013.00068

Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet 2012;380:651-9. DOI: https://doi.org/10.1016/S0140-6736(12)60988-X

Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014;371:1198-207. DOI: https://doi.org/10.1056/NEJMoa1403290

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Last accessed: February 2019. Available from: https://www.ucalgary.ca/icancontrolasthma/files/icancontrolasthma/wms-gina-2016-main-report-final.pdf

Shantakumar S, Yu-Fan H, Beale J, et al. An observational study to characterize severe eosinophilic asthma in New Zealand. Eur Respir J 2018;52:PA1155. DOI: https://doi.org/10.1183/13993003.congress-2018.PA1155

Respiratory Subcommittee of the Pharmacology and Therapeutics Advisory Committee (PTAC). Mepolizumab for severe eosinophilic asthma - minutes of the 2017 PTAC meeting. Last accessed: October 2019. Available from: https://www.pharmac.govt.nz/assets/ptac-respiratory-subcommittee-minutes-2017-08.pdf

Kerkhof M, Tran TN, Soriano JB, et al. Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population. Thorax 2018;73:116-24. DOI: https://doi.org/10.1136/thoraxjnl-2017-210531

Shantakumar S, Yu-Fan H, Li-Wen T, et al. A retrospective observational study to characterize severe eosinophilic asthma in Taiwan. Eur Respir J 2018;52:PA3917. doi: 10.1183/13993003.congress-2018.PA3917 DOI: https://doi.org/10.1183/13993003.congress-2018.PA3917

Lang JE, Hossain J, Smith K, et al. Asthma severity, exacerbation risk, and controller treatment burden in underweight and obese children. J Asthma 2012;49:456-63. DOI: https://doi.org/10.3109/02770903.2012.677895

Jarjour NN, Erzurum SC, Bleecker ER, et al. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Am J Respir Crit Care Med 2012;185:356-62. DOI: https://doi.org/10.1164/rccm.201107-1317PP

de Carvalho-Pinto RM, Cukier A, Angelini L, et al. Clinical characteristics and possible phenotypes of an adult severe asthma population. Respir Med 2012;106:47-56. DOI: https://doi.org/10.1016/j.rmed.2011.08.013

Barnard L, Zhang J. The impact of respiratory disease in New Zealand: 2018 update. Last accessed: April 2019. Available from: https://s3-ap-southeast-2.amazonaws.com/assets.asthmafoundation.org.nz/images/NZ-Impact-Report-2018_FINAL.pdf

New Zealand Ministry of Health. Tatau Kahukura Māori Health Chart Book 2010. Wellington: Ministry of Health, 2010.

Lewis S, Hales S, Slater T, et al. Geographical variation in the prevalence of asthma symptoms in New Zealand. N Z Med J 1997;110:286-9.

New Zealand Ministry of Health. Ngā mana hauora tūtohu: Health status indicators - Asthma. 2018. Last accessed: March 2019. Available from: https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/respiratory-disease.

Robson B, Harris R. Hauora: Māori Standards of Health IV. A study of the years 2000–2005. Wellington: Te Ropu Rangahau Hauora a Eru Pomare; 2007.

Beasley R, Hancox RJ, Harwood M, et al. Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide. N Z Med J 2016;129:83-102.

New Zealand Ministry of Health. Neighbourhood deprivation. 2013. Last accessed: April 2019. Available from: https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-awe-o-te-hauora-socioeconomic-determinants-health/neighbourhood-deprivation

Poyser MA, Nelson H, Ehrlich RI, et al. Socioeconomic deprivation and asthma prevalence and severity in young adolescents. Eur Respir J 2002;19:892. DOI: https://doi.org/10.1183/09031936.02.00238402

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Published
2020-08-03
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Issue
Section
Original Research Articles
Conflict of interest statement
SS and Y-FH are employees of GSK and hold stocks/shares in GSK, JB is an employee of GSK but does not hold stock/shares in GSK, BG is a shareholder in HealthStat Ltd. that received funding to conduct the study
Supporting Agencies
This study was sponsored by GSK (PRJ2407/208970)
Keywords:
Severe eosinophilic asthma, New Zealand, epidemiology, costs
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How to Cite
Shantakumar, S., Ho, Y.-F., Beale, J., & Gribben, B. (2020). Characterization and burden of severe eosinophilic asthma in New Zealand: Results from the HealthStat Database. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.662