Original Articles
Cost and Management of Asthma Exacerbations in Spanish Hospitals (COAX Study in Hospital Services)
L. Borderías Claua,
, M. Zabaleta Murguiondab, J.A. Riesco Mirandac, C. Pellicer Ciscard, J. R. Hernández Hernándeze, T. Carrillo Díazf, G. Lumbreras Garcíag
Corresponding author
lborderias@separ.es
Correspondence: Dr. L. Borderías Clau. Servicio de Neumología. Hospital San Jorge. Avda. Martínez de Velaco, 36. 22004 Huesca. España
Correspondence: Dr. L. Borderías Clau. Servicio de Neumología. Hospital San Jorge. Avda. Martínez de Velaco, 36. 22004 Huesca. España
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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Borderías Clau. Servicio de Neumología. Hospital San Jorge. Avda. Martínez de Velaco, 36. 22004 Huesca. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-04-06" "fechaAceptado" => "2004-11-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154100" "palabras" => array:4 [ 0 => "Asthma" 1 => "Resource management" 2 => "Hospital care" 3 => "Asthma exacerbation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154101" "palabras" => array:4 [ 0 => "Asma" 1 => "Utilización de recursos" 2 => "Atención hospitalaria" 3 => "Crisis asmática" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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 β<span class="elsevierStyleInf">2</span> 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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">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 β<span class="elsevierStyleInf">2</span> agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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 β<span class="elsevierStyleInf">2</span> 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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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 β<span class="elsevierStyleInf">2</span> 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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Global Strategy for Asthma management and prevention" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "NHLBI/WHO Workshop Report" "fecha" => "1998" "editorial" => "National Institute of Health" "editorialLocalizacion" => "Bethesda" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring the economic burden in asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B Jönsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Asthma's impact on society. 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| Year/Month | Html | Total | |
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| 2024 November | 4 | 3 | 7 |
| 2024 October | 32 | 17 | 49 |
| 2024 September | 30 | 25 | 55 |
| 2024 August | 40 | 50 | 90 |
| 2024 July | 25 | 26 | 51 |
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| 2024 April | 18 | 27 | 45 |
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| 2023 December | 0 | 2 | 2 |
| 2023 March | 2 | 2 | 4 |
| 2023 February | 12 | 17 | 29 |
| 2023 January | 28 | 29 | 57 |
| 2022 December | 29 | 31 | 60 |
| 2022 November | 26 | 19 | 45 |
| 2022 October | 30 | 28 | 58 |
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| 2022 June | 22 | 28 | 50 |
| 2022 May | 21 | 28 | 49 |
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| 2021 September | 21 | 42 | 63 |
| 2021 August | 14 | 21 | 35 |
| 2021 July | 10 | 29 | 39 |
| 2021 June | 23 | 40 | 63 |
| 2021 May | 18 | 23 | 41 |
| 2021 April | 88 | 80 | 168 |
| 2021 March | 33 | 14 | 47 |
| 2021 February | 14 | 21 | 35 |
| 2021 January | 14 | 12 | 26 |
| 2020 December | 12 | 15 | 27 |
| 2020 November | 5 | 11 | 16 |
| 2020 October | 10 | 12 | 22 |
| 2020 September | 10 | 8 | 18 |
| 2020 August | 13 | 9 | 22 |
| 2020 July | 13 | 13 | 26 |
| 2020 June | 8 | 5 | 13 |
| 2020 May | 11 | 14 | 25 |
| 2020 April | 12 | 17 | 29 |
| 2020 March | 18 | 13 | 31 |
| 2020 February | 12 | 11 | 23 |
| 2020 January | 31 | 18 | 49 |
| 2019 December | 33 | 33 | 66 |
| 2019 November | 25 | 17 | 42 |
| 2019 October | 16 | 7 | 23 |
| 2019 September | 15 | 9 | 24 |
| 2019 August | 15 | 10 | 25 |
| 2019 July | 20 | 19 | 39 |
| 2019 June | 9 | 7 | 16 |
| 2019 May | 16 | 9 | 25 |
| 2019 April | 19 | 13 | 32 |
| 2019 March | 16 | 14 | 30 |
| 2019 February | 15 | 9 | 24 |
| 2019 January | 8 | 4 | 12 |
| 2018 December | 10 | 12 | 22 |
| 2018 November | 14 | 12 | 26 |
| 2018 October | 16 | 13 | 29 |
| 2018 September | 9 | 13 | 22 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 4 | 6 | 10 |
| 2018 March | 4 | 3 | 7 |
| 2018 February | 5 | 6 | 11 |
| 2018 January | 4 | 7 | 11 |
| 2017 December | 7 | 4 | 11 |
| 2017 November | 4 | 4 | 8 |
| 2017 October | 7 | 5 | 12 |
| 2017 September | 4 | 11 | 15 |
| 2017 August | 5 | 10 | 15 |
| 2017 July | 2 | 16 | 18 |
| 2017 June | 5 | 11 | 16 |
| 2017 May | 5 | 13 | 18 |
| 2017 April | 2 | 3 | 5 |
| 2017 March | 3 | 27 | 30 |
| 2017 February | 2 | 4 | 6 |
| 2017 January | 2 | 3 | 5 |
| 2016 December | 10 | 10 | 20 |
| 2016 November | 13 | 8 | 21 |
| 2016 October | 14 | 12 | 26 |
| 2016 September | 14 | 16 | 30 |
| 2016 August | 10 | 4 | 14 |
| 2016 July | 6 | 7 | 13 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 51 | 1 | 52 |
| 2015 September | 40 | 12 | 52 |
| 2015 August | 44 | 11 | 55 |
| 2015 July | 45 | 10 | 55 |
| 2015 June | 51 | 7 | 58 |
| 2015 May | 52 | 6 | 58 |
| 2015 April | 71 | 16 | 87 |
| 2015 March | 40 | 9 | 49 |
| 2015 February | 41 | 6 | 47 |
| 2015 January | 41 | 9 | 50 |
| 2014 December | 34 | 2 | 36 |
| 2014 November | 34 | 10 | 44 |
| 2014 October | 45 | 12 | 57 |
| 2014 September | 38 | 10 | 48 |
| 2014 August | 30 | 10 | 40 |
| 2014 July | 31 | 8 | 39 |
| 2014 June | 47 | 7 | 54 |
| 2014 May | 40 | 11 | 51 |
| 2014 April | 52 | 10 | 62 |
| 2014 March | 48 | 10 | 58 |
| 2014 February | 77 | 16 | 93 |
| 2014 January | 35 | 9 | 44 |
| 2013 December | 49 | 9 | 58 |
| 2013 November | 39 | 8 | 47 |
| 2013 October | 49 | 14 | 63 |
| 2013 September | 39 | 10 | 49 |
| 2013 August | 42 | 14 | 56 |
| 2013 July | 45 | 15 | 60 |
| 2013 June | 33 | 6 | 39 |
| 2013 May | 35 | 4 | 39 |
| 2013 April | 21 | 7 | 28 |
| 2013 March | 11 | 3 | 14 |
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