Costs of Oral Corticosteroid Use in Patients with Severe Asthma With/Without Chronic Rhinosinusitis with Nasal Polyps: Data from the Italian SANI Registry

Overview

Journal Adv Ther

Date 2025 Jan 4

PMID 39754702

Authors

Enrico Heffler

Francesco Blasi

Pierluigi Paggiaro

Giorgio Walter Canonica

Affiliations

Soon will be listed here.

Abstract

Introduction: The burden of severe asthma on patients, especially on those with concomitant chronic rhinosinusitis with nasal polyps (CRSwNP), is substantial. Treatment intensification with oral corticosteroids is a common strategy for managing severe asthma exacerbations; however, prolonged exposure to systemic corticosteroids is associated with multisystem toxicity. This study aimed to quantify the association between oral corticosteroid use and annual asthma-related costs in patients with severe asthma with or without CRSwNP.

Methods: This pharmacoeconomic analysis was based on data from the Severe Asthma Network in Italy (SANI) registry. Asthma-related costs were estimated in the context of the Italian healthcare system and included exacerbations requiring treatment intensification, unplanned visits, admissions to hospital and emergency/intensive care units, and lost workdays. For each item, the mean annual cost per patient was estimated based on national tariffs and the frequency of the event. To quantify the association between oral corticosteroid treatment and costs, the study cohort was stratified according to oral corticosteroid use in the 1-year preceding inclusion in the SANI registry.

Results: A total of 669 patients from the SANI registry were included in the present analysis, 255 of whom had concomitant CRSwNP. Corticosteroid use was associated with significantly higher annual disease-related costs per patient compared with no corticosteroid use. Compared with the overall study cohort and patients without CRSwNP, patients with CRSwNP had higher disease-related costs (higher by €1307 and €1869, respectively).

Conclusion: Use of corticosteroids, in particular systemic corticosteroids, is associated with an increase in asthma-related costs. The concomitant presence of CRSwNP impacts negatively on costs. This study suggests that a thorough analysis of costs, expected benefits, and occurrence of adverse events is required when selecting treatment intensification strategies for managing uncontrolled severe asthma.

Citing Articles

The Role of KI67 in Predicting Post-ESS (Endoscopic Sinus Surgery) Outcomes in CRSwNP (Chronic Rhinosinusitis With Nasal Polyps).

Tanase M, Cosgarea M, Hendea R, Ujvary P, Dindelegan M, Radeanu G Cureus. 2025; 17(2):e79748.

PMID: 40017577 PMC: 11867708. DOI: 10.7759/cureus.79748.

References

Volmer T, Effenberger T, Trautner C, Buhl R . Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Eur Respir J. 2018; 52(4). DOI: 10.1183/13993003.00703-2018. View

Sweeney J, Patterson C, Menzies-Gow A, Niven R, Mansur A, Bucknall C . Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax. 2016; 71(4):339-46. DOI: 10.1136/thoraxjnl-2015-207630. View

Schleich F, Brusselle G, Louis R, Vandenplas O, Michils A, Pilette C . Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). Respir Med. 2014; 108(12):1723-32. DOI: 10.1016/j.rmed.2014.10.007. View

Langdon C, Mullol J . Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy. 2016; 9:45-53. PMC: 4798207. DOI: 10.2147/JAA.S86251. View

Foster J, McDonald V, Guo M, Reddel H . "I have lost in every facet of my life": the hidden burden of severe asthma. Eur Respir J. 2017; 50(3). DOI: 10.1183/13993003.00765-2017. View

Lefebvre P, Duh M, Lafeuille M, Gozalo L, Desai U, Robitaille M . Acute and chronic systemic corticosteroid-related complications in patients with severe asthma. J Allergy Clin Immunol. 2015; 136(6):1488-1495. DOI: 10.1016/j.jaci.2015.07.046. View

Barry L, ONeill C, Patterson C, Sweeney J, Price D, Heaney L . Age and Sex Associations with Systemic Corticosteroid-Induced Morbidity in Asthma. J Allergy Clin Immunol Pract. 2018; 6(6):2014-2023.e2. DOI: 10.1016/j.jaip.2018.04.008. View

McDowell P, Stone J, Heaney L . The Role of Quantification of Glucocorticoid-associated Toxicity in Severe Asthma. J Cell Immunol. 2021; 3(1):31-35. PMC: 8045989. DOI: 10.33696/immunology.3.074. View

Senna G, Guerriero M, Paggiaro P, Blasi F, Caminati M, Heffler E . SANI-Severe Asthma Network in Italy: a way forward to monitor severe asthma. Clin Mol Allergy. 2017; 15:9. PMC: 5385599. DOI: 10.1186/s12948-017-0065-4. View

10.

Smith J, Noble M, Musgrave S, Murdoch J, Price G, Barton G . The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care. Thorax. 2012; 67(12):1052-60. DOI: 10.1136/thoraxjnl-2012-202093. View

11.

ONeill S, Sweeney J, Patterson C, Menzies-Gow A, Niven R, Mansur A . The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry. Thorax. 2014; 70(4):376-8. DOI: 10.1136/thoraxjnl-2013-204114. View

12.

Bourdin A, Adcock I, Berger P, Bonniaud P, Chanson P, Chenivesse C . How can we minimise the use of regular oral corticosteroids in asthma?. Eur Respir Rev. 2020; 29(155). PMC: 9488989. DOI: 10.1183/16000617.0085-2019. View

13.

Canonica G, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A . Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the (). World Allergy Organ J. 2020; 13(10):100464. PMC: 7509464. DOI: 10.1016/j.waojou.2020.100464. View

14.

Zafari Z, Sadatsafavi M, Chen W, FitzGerald J . The projected economic and health burden of sub-optimal asthma control in Canada. Respir Med. 2018; 138:7-12. DOI: 10.1016/j.rmed.2018.03.018. View

15.

Sweeney J, Brightling C, Menzies-Gow A, Niven R, Patterson C, Heaney L . Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry. Thorax. 2012; 67(8):754-6. PMC: 3402747. DOI: 10.1136/thoraxjnl-2012-201869. View

16.

von Bulow A, Kriegbaum M, Backer V, Porsbjerg C . The prevalence of severe asthma and low asthma control among Danish adults. J Allergy Clin Immunol Pract. 2014; 2(6):759-67. DOI: 10.1016/j.jaip.2014.05.005. View

17.

FitzGerald J, Tran T, Alacqua M, Altraja A, Backer V, Bjermer L . International severe asthma registry (ISAR): protocol for a global registry. BMC Med Res Methodol. 2020; 20(1):212. PMC: 7439682. DOI: 10.1186/s12874-020-01065-0. View

18.

Barry L, Sweeney J, ONeill C, Price D, Heaney L . The cost of systemic corticosteroid-induced morbidity in severe asthma: a health economic analysis. Respir Res. 2017; 18(1):129. PMC: 5485660. DOI: 10.1186/s12931-017-0614-x. View

19.

Giombi F, Pace G, Pirola F, Cerasuolo M, Ferreli F, Mercante G . Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?. Int J Mol Sci. 2024; 25(2). PMC: 10815382. DOI: 10.3390/ijms25020730. View

20.

Canonica G, Malvezzi L, Blasi F, Paggiaro P, Mantero M, Senna G . Chronic rhinosinusitis with nasal polyps impact in severe asthma patients: Evidences from the Severe Asthma Network Italy (SANI) registry. Respir Med. 2020; 166:105947. DOI: 10.1016/j.rmed.2020.105947. View