INTRODUCTION
Asthma is one of the most common chronic diseases in children;(1)
prevalence in Europe ranges from 2.2% to 11.9%.(2) Asthma in children
accounts for approximately half of asthma-related hospitalizations in
Canada, (3) and so it is accountable for huge costs, which are
comprehensively very difficult to estimate as they include:
- Direct costs (spent resources) incurred by the health system, society,
family and individual patient: healthcare and non-healthcare
costs.(4,5)
- Indirect costs (unearned resources) because of productivity losses due
to morbidity and mortality, borne by the individual, family, society,
or the employer.(4,5)
- Intangible costs, related to impairment of quality of life (QoL),
limitation of physical and school activities, with consequences such
as depression, fear, grief, stress, anxiety, etc.(5)
In the US, the total direct costs of pediatric asthma in 2013 accounted
for $5.9 billion, mainly due to hospitalizations and emergency
department visits.(6) In this context, severe asthma accounts for the
majority of asthma costs. Most of the proposed definitions for severity
include poor symptom control and use of high doses of medication, and
many also include frequent exacerbations.(7) Despite its low prevalence
(up to 5% of cases), severe forms account for a considerable proportion
of the disease-related costs.(7,8) Poor symptom control, in addition, is
associated with lower QoL of asthmatic children and their
caregivers.(9,10)
Children aged ≥ 6 years with severe persistent allergic asthma (SPAA)
not controlled with high-dose inhaled corticosteroids (ICS) plus
long-acting beta‑agonists (LABA) have the option to receive targeted
therapy with omalizumab (OMZ).(1) This monoclonal antibody prevents IgE
from binding to the FcɛRI receptors, avoids the activation and
triggering of the allergic cascade, and downregulates the production of
IgE.(11) Clinical trials (12–14) and real life studies (15–18) have
demonstrated the safety, efficacy and effectiveness of OMZ in pediatric
patients, showing a reduction of symptoms, exacerbations, use of rescue
medication, medical visits and hospitalizations, and an improvement in
QoL.
Although there are some studies analyzing the costs in pediatric
asthma,(2,5,8,19,20) the majority of pharmacoeconomic studies involve
general population. The specific evaluation in severe pediatric asthma
is needed as the use of biologic treatments in children has
significantly increased the direct medical costs.
The aim of our study was to evaluate the evolution of direct medical
costs related to healthcare resources and medication in a large cohort
of children with SPAA treated with OMZ, followed up to 6 years since the
beginning of the treatment.