PURPOSE: Poorly controlled asthma is associated with increased health care utilization. Omalizumab is recommended as an add-on therapy for patients with moderate-to-severe persistent allergy-related asthma with inadequate control. While studies have shown reduced exacerbations, need for corticosteroids, and improved symptom control with use of omalizumab, no study has specifically looked at the effect on healthcare utilization.
METHODS: We performed a retrospective, before-and-after study of adults receiving omalizumab for asthma at six military tertiary care centers. Data was obtained through review of electronic medical records of identified patients. Total health care visits, asthma-related health care visits, ER visits and hospitalizations, and doses of oral steroids were assessed in the year prior to and year after starting omalizumab therapy.
RESULTS: Twenty-six patients were included in the analysis including 9 males (35%) and 17 females (65%). There was a statistically significant increase in the mean number of total clinic visits, increasing from 21.5 to 37.4 in the years prior to and after initiation of omalizumab respectively (p=0.003). There was also a significant increase in the mean number of asthma-related clinic visits, increasing from 10.3 to 21.0 (p <0.001). This increase was primarily due to visits for omalizumab administration, for when these visits were removed there was no significant difference in the mean number of asthma-related visits (p=0.31). No statistically significant decrease was seen in the mean number of ER visits or hospitalizations in the 12 months prior to and after initiation of omalizumab (1.0 vs. 0.53, p=0.18). There was also no significant difference in the mean number of steroid doses (2.62 vs. 2.48, p=0.745).
CONCLUSIONS: Healthcare utilization among patients with moderate-to-severe persistent asthma is high. Initiation of omalizumab therapy results in a significant increase in both total and asthma-related clinic visits; however, this difference appears to be accounted for by visits for omalizumab injection. No statistically significant difference in the use of oral corticosteroids or ER visits and hospitalizations was demonstrated between the year prior to and following initiation of omalizumab in our small cohort.
CLINICAL IMPLICATIONS: Healthcare utilization increases significantly following initiation of omalizumab therapy. With expanding use of this therapy, already busy clinics may face issues with access to care.
DISCLOSURE: The following authors have nothing to disclose: Samir Patel, Vanya Wagler, Monica Arbogast, Aaron Holley, Christopher King
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