Editorial
Pharmaeconomics in Asthma
Farmaeconomía en Asma
a Unidad de Asma, Laboratorio de Exploración Funcional, Departamento de Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
c Universidad del País Vasco (UPV-EHU), Leioa, Bizkaia, Spain
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Gáldiz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Nuria" "apellidos" => "Marina" "email" => array:1 [ 0 => "nuria.marinamalanda@osakidetza.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan B." "apellidos" => "Gáldiz" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Asma, Laboratorio de Exploración Funcional, Departamento de Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad del País Vasco (UPV-EHU), Leioa, Bizkaia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Farmaeconomía en Asma" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is a serious health problem associated with high morbidity and mortality. It affects all age groups, and prevalence is increasing worldwide.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Despite regional differences, prevalence in Spain is estimated at up to 4.7%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Asthma is classified according to severity, with the most severe and poorly controlled forms (3.9% of all asthmatics) causing the greatest impact on both sufferers and healthcare systems.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The disease is costly in terms of resources, and places a considerable economic burden not only on the national health system, but also on patients and their families. Society as a whole also pays a heavy price in terms of loss of quality of life, absenteeism from work and school, use of resources (visits to the doctor, complementary tests, hospitalizations, treatment, etc.), and mortality. Spain currently allocates nearly 8.9% of its gross domestic product to its healthcare budget, and asthma alone is estimated to absorb between 1% and 2% of total healthcare expenditure.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The AsmaCost study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> published in 2009 estimated the annual cost of an asthma patient at €1726, a figure that increases in patients over 65 years of age and in those with severe disease. Based on these findings, the overall annual cost of asthma is Spain has been estimated at €1.48 billion. It is important to bear in mind that uncontrolled asthma accounts for 70% of the total cost of the disease, a fact that highlights the importance of achieving the level of control recommended in clinical guidelines.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> The situation is further aggravated by high rates of therapeutic noncompliance, even among patients with difficult-to-control asthma. Poor compliance among the subgroup of patients with difficult-to-control asthma is an important issue, as some of the therapies recommended in clinical guidelines as final treatment steps are extremely costly,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> yet they are often indicated in patients with poor adherence to treatment in previous steps.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">How and where to treat patients with severe, difficult-to-control asthma is widely debated, and strategies are shaped by the characteristics of each healthcare system. In Spain, a number of specialized asthma clinics have been set up in recent years with the aim of improving evaluation and management of this patient subgroup. In order to optimize resource management, these clinics are evaluated and accredited by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Very few studies have explored the cost-effectiveness of asthma clinics. Domingo Ribas<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and Pérez de Llano<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> found them to be cost-effective, based on an evaluation of their own experience in this context. These authors found that patients were better controlled, with fewer hospitalizations and emergency medical treatment for exacerbations. However, the cost of treatment was higher due to the use of more expensive therapies.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Despite this, the authors found that asthma clinics ultimately save money, as the benefits of improved control of the disease outweigh the higher cost of treatment. It is important to emphasize that guidelines call on clinicians to make wider use of preventive therapies and to improve patient education, both of which are among the fundamental objectives of these specialized clinics.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">New personalized asthma therapies are usually reserved for severe, uncontrolled patients. This factor has a significant impact on asthma-related healthcare costs, as the new biological treatments are extremely costly. One such drug, omalizumab, the first anti-immunoglobulin E antibody marketed for patients with severe allergic asthma, is recommended in the last treatment step in clinical guidelines.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> The cost-effectiveness of this drug has been evaluated in various studies, and it has been shown to reduce exacerbations and improve health-related quality of life.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Levy et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> estimated the cost of each exacerbation prevented at €462.08, and the cost of each quality-adjusted life year (QALY), or 1 year of life lived in perfect health, at €26,864.89. On the basis of these figures, the incremental cost-effectiveness ratio of omalizumab is within budgetary limits. In order to reduce the cost of this therapy, Chiner et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> have suggested that omalizumab, hitherto administered almost exclusively in hospitals, could also be administered in an outpatient setting, even though it should be prescribed by a an asthma specialist. According to the authors, outpatient administration is less costly and achieves the same clinical outcome as hospital administration. Other biologics with different profiles but presumably with equally high prices will shortly be available for asthma patients. As a prerequisite for administration of these new treatments, patients must be carefully characterized, and the drugs can only be administered by trained medical personnel. The healthcare authorities, in an attempt to make more effective use of these therapies, might ultimately require them to be prescribed by specialist asthma clinics.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, asthma is a highly prevalent disease with a considerable proportion of severe uncontrolled patients who consume most of the resources allocated to treat this condition. For this reason, it is essential to perform cost-effectiveness analyses on which to base decisions to incorporate new procedures or treatments into the healthcare system. These analyses can allow experts to evaluate costs when submitting proposals to the authorities, and will ensure the best and most cost-effective use of our limited healthcare resources.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marina N, Gáldiz JB. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 3 | 11 |
| 2024 October | 56 | 15 | 71 |
| 2024 September | 69 | 12 | 81 |
| 2024 August | 85 | 34 | 119 |
| 2024 July | 42 | 15 | 57 |
| 2024 June | 58 | 13 | 71 |
| 2024 May | 85 | 25 | 110 |
| 2024 April | 32 | 19 | 51 |
| 2024 March | 53 | 9 | 62 |
| 2024 February | 28 | 22 | 50 |
| 2023 March | 8 | 2 | 10 |
| 2023 February | 35 | 20 | 55 |
| 2023 January | 23 | 25 | 48 |
| 2022 December | 44 | 22 | 66 |
| 2022 November | 43 | 21 | 64 |
| 2022 October | 33 | 33 | 66 |
| 2022 September | 24 | 20 | 44 |
| 2022 August | 38 | 35 | 73 |
| 2022 July | 32 | 46 | 78 |
| 2022 June | 36 | 30 | 66 |
| 2022 May | 48 | 31 | 79 |
| 2022 April | 68 | 18 | 86 |
| 2022 March | 75 | 38 | 113 |
| 2022 February | 85 | 33 | 118 |
| 2022 January | 62 | 42 | 104 |
| 2021 December | 32 | 30 | 62 |
| 2021 November | 54 | 48 | 102 |
| 2021 October | 39 | 45 | 84 |
| 2021 September | 20 | 43 | 63 |
| 2021 August | 19 | 48 | 67 |
| 2021 July | 19 | 27 | 46 |
| 2021 June | 28 | 31 | 59 |
| 2021 May | 27 | 40 | 67 |
| 2021 April | 83 | 75 | 158 |
| 2021 March | 46 | 24 | 70 |
| 2021 February | 21 | 30 | 51 |
| 2021 January | 22 | 20 | 42 |
| 2020 December | 23 | 26 | 49 |
| 2020 November | 18 | 19 | 37 |
| 2020 October | 21 | 14 | 35 |
| 2020 September | 11 | 9 | 20 |
| 2020 August | 15 | 14 | 29 |
| 2020 July | 25 | 19 | 44 |
| 2020 June | 27 | 22 | 49 |
| 2020 May | 22 | 22 | 44 |
| 2020 April | 28 | 16 | 44 |
| 2020 March | 23 | 13 | 36 |
| 2020 February | 20 | 21 | 41 |
| 2020 January | 17 | 17 | 34 |
| 2019 December | 36 | 11 | 47 |
| 2019 November | 17 | 20 | 37 |
| 2019 October | 19 | 11 | 30 |
| 2019 September | 21 | 14 | 35 |
| 2019 August | 26 | 13 | 39 |
| 2019 July | 21 | 16 | 37 |
| 2019 June | 13 | 5 | 18 |
| 2019 May | 15 | 20 | 35 |
| 2019 April | 35 | 24 | 59 |
| 2019 March | 23 | 19 | 42 |
| 2019 February | 27 | 20 | 47 |
| 2019 January | 24 | 13 | 37 |
| 2018 December | 31 | 18 | 49 |
| 2018 November | 34 | 21 | 55 |
| 2018 October | 65 | 18 | 83 |
| 2018 September | 16 | 8 | 24 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 15 | 4 | 19 |
| 2018 March | 27 | 6 | 33 |
| 2018 February | 25 | 8 | 33 |
| 2018 January | 25 | 5 | 30 |
| 2017 December | 30 | 3 | 33 |
| 2017 November | 25 | 8 | 33 |
| 2017 October | 22 | 8 | 30 |
| 2017 September | 23 | 11 | 34 |
| 2017 August | 18 | 8 | 26 |
| 2017 July | 22 | 9 | 31 |
| 2017 June | 32 | 13 | 45 |
| 2017 May | 34 | 15 | 49 |
| 2017 April | 28 | 12 | 40 |
| 2017 March | 15 | 9 | 24 |
| 2017 February | 12 | 5 | 17 |
| 2017 January | 9 | 4 | 13 |
| 2016 December | 25 | 17 | 42 |
| 2016 November | 33 | 26 | 59 |
| 2016 October | 28 | 30 | 58 |
| 2016 September | 25 | 8 | 33 |
| 2016 August | 42 | 6 | 48 |
| 2016 July | 39 | 11 | 50 |
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