Economic impact of oral corticosteroids in severe asthmatics: a simulation study in selected European countries

Background: Despite representing only 5% of cases, severe asthmatics (SA) consume roughly 50% of the global asthma healthcare resources due to unscheduled visits, hospitalizations, therapy, and management of oral corticosteroid (OCS) adverse events (AEs). Guidelines discourage OCS usage, particularly if continuous and at high doses, due to increased risk of AEs. Aims: This study quantifies the economic burden of OCS-related AEs in newly diagnosed SA patients in selected European countries over 10 years, and that brought about by prevalent SA OCS-dependent patients. Methods: From the National Health System perspective, a budget impact model (BIM) simulated total AE costs in all newly diagnosed SA patients in various OCS-sparing scenarios. In this study, AE costs due to exclusive OCS use were compared to AE costs linked to exclusive use of biologics. To quantify the overall OCS-related AE burden, simulations were repeated for prevalent SA patients continuously treated with OCS. Epidemiological data, AEs, and costs were collected from the literature. Uncertainty was assessed via sensitivity analyses. Results: Assuming that OCS-related AEs would incur after 3 years of OCS continuous use, the BIM quantified potential savings over 10 years among SA incident cases: 4.5M€ in Belgium, 6.9M€ in Italy, 5.5M€ in Poland, 7.8M€ in Spain, 0.4M€ in Slovenia, 2.9M€ in Sweden. Considering the 2,180,740 prevalent SA patients across countries, the BIM estimated at 4.9 billion € the total 10-year burden due to OCS-usage, equivalent to 2,336€ per patient per year. Conclusions: Results show that preventing OCS use in newly diagnosed SA patients can lead to consistent savings over the long-term.