Analisi real-world dei disturbi ostruttivi delle vie respiratorie: caratterizzazione, assistenza sanitaria e costi

INTRODUCTION This analysis has described the burden of patients with asthma, chronic obstructive pulmonary disease (COPD), asthma/COPD mixed conditions or undefined obstructive diseases (UODs), from the Italian National Health System point of view. METHODS In the accrual period (2015), starting from the ReS database, a record linkage among demographic, pharmaceuticals, hospitalizations and outpatient specialist services databases has identified patients affected by only asthma, only COPD, asthma/COPD and UODs. From the less recent date of identification, each patient was analyzed in one previous year and in two years of follow-up (at most up to 12/31/2017). In the accrual period, in the previous one and in 2-year follow-up sinus polyps was researched. One-year free filled respiratory (ATC code R03) and concomitant prescriptions, outpatient specialist services, hospitalizations were described. Two-year costs were assessed annually. RESULTS In 2015, 110,453 subjects with asthma (16.6 x1000 ≥12 years old), 229,747 with COPD, 8828 with asthma/COPD (55.5 x1000 and 2.1 x1000 ≥40 years, respectively) and 75,072 with UODs (27.2 x1000 subjects aged 40 to 65) were selected. Sinus polyps was found in 753 patients with asthma, 181 with COPD and 122 with asthma/COPD. A very high use of inhaled corticosteroids - ICS (R03AB) as monotherapy and as fixed association ICS/LABA and of cardiovascular drugs was highlighted among patients with COPD and asthma/COPD. The spirometry test was used in 21.4% patients with asthma/COPD, in 9.2% with asthma, in 8.6% with COPD and in 5.8% with UODs. Subjects with COPD and asthma/COPD were the most frequently hospitalized, mainly due to respiratory and cardiovascular causes, and those with the longest in-hospital stay. On average, the mean overall one-year expenditure per COPD or asthma/COPD patient was three times higher than per asthma or UOD one (€3508/€3613 vs €942/€1394, respectively). CONCLUSIONS Concomitant drugs and hospitalizations due to other causes than respiratory ones accounted for the highest expenses. In general, comorbidities and cardiopulmonary complications played a key role in obstructive airway disease managing and controlling, by determining unsustainable socio-economic impacts.