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Vol. 41. Issue 6.
Pages 313-321 (June 2005)
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Vol. 41. Issue 6.
Pages 313-321 (June 2005)
Original Articles
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Cost and Management of Asthma Exacerbations in Spanish Hospitals (COAX Study in Hospital Services)
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L. Borderías Claua,
Corresponding author
lborderias@separ.es

Correspondence: Dr. L. Borderías Clau. Servicio de Neumología. Hospital San Jorge. Avda. Martínez de Velaco, 36. 22004 Huesca. España
, M. Zabaleta Murguiondab, J.A. Riesco Mirandac, C. Pellicer Ciscard, J. R. Hernández Hernándeze, T. Carrillo Díazf, G. Lumbreras Garcíag
a Servicio de Neumología, Hospital San Jorge, Huesca, Spain
b Servicio de Neumología, Hospital Comarcal, Laredo, Santander, Spain
c Servicio de Neumología, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
d Servicio de Neumología, Hospital F. de Borja, Gandía, Valencia, Spain
e Servicio de Neumología, Hospital Virgen de Sonsoles, Avila, Spain
f Servicio de Alergología, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
g Centro de Salud, Villaviciosa de Odón, Madrid, Spain
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Objective

The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries.

Patients and methods

Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000).

Results

According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting β2 agonists. The mean cost was €1555.70 (95% confidence interval [CI], €1237.60-€1907.00), of which 93.8% (€1460.60; 95% CI, €1152.50-€1779.40) was due to direct costs, and 6.2% (€95.1; 95% CI, €35.5-€177) to indirect costs. Cost rose with increasing severity of the exacerbation—€292.60 for a mild exacerbation, €1230.50 for a moderate exacerbation, and €3543.10 for a severe exacerbation.

Conclusions

The mean cost was €1555.70. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting β2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.

Key words:
Asthma
Resource management
Hospital care
Asthma exacerbation
Objetivo

La prevalencia y el gasto sanitario originado por el asma están aumentando progresivamente en los países desarrollados. El 70% del coste total está producido por exacerbaciones. El objetivo principal del estudio fue conocer el coste hospitalario de una crisis asmática en nuestro medio. Como objetivo secundario se quiso conocer cuál era el tratamiento de mantenimiento para el control del asma que utilizaban los pacientes antes de la agudización asmática y su tratamiento. El estudio formaba parte de uno más amplio (COAX II) realizado en 8 países europeos que pretendía los mismos objetivos en cada país.

Pacientes y métodos

Estudio observacional prospectivo en el que se incluyó a 126 pacientes con crisis asmática tratados de forma habitual en 6 hospitales españoles durante un período de 3 meses (del 1 de enero al 31 de marzo de 2000).

Resultados

Siguiendo los criterios de la Global Initiative for Asthma, el 33,3% de las crisis fueron leves, el 38,9% moderadas, el 26,2% graves y el 1,6% con riesgo de parada respiratoria inminente. La utilización de corticoides era generalizada en los pacientes con asma moderada y grave, pero sólo el 68% de los pacientes con asma grave seguían tratamiento con agonistas β2 de larga duración. El coste medio fue de 1.555,7 € (intervalo de confianza [IC] del 95%, 1.237,6-1.907), el 93,8% (1.460,6 €; IC del 95%, 1.152,5-1.779,4) debido a costes directos y el 6,2% (95,1 €; IC del 95%, 35,5-177) a costes indirectos. El coste se incrementaba a medida que la crisis era más grave: 292,6 € para una crisis leve, 1.230,5 € para la crisis moderada y 3.543,1 € para la crisis grave.

Conclusiones

El coste medio fue de 1.555,7 €. Los costes de las crisis moderadas y graves eran 4 y 12 veces mayores que los de la leve, respectivamente. Se observó una infrautilización de los β2 de larga duración con respecto a las recomendaciones de las guías en el tratamiento del asma persistente moderada y grave que originaba crisis de asma.

Palabras clave:
Asma
Utilización de recursos
Atención hospitalaria
Crisis asmática
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This study was performed with the support of the Department of Pharmacoeconomics of GlaxoSmithKline in Madrid, who assisted with data processing, particularly for the economic analysis in the study.

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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