Allergy and Airway: Asthma and Allergy |

Outcomes After Bronchial Thermoplasty: County vs Private Hospital Settings FREE TO VIEW

Ching-Fei Chang, MD; Edward Hu, MD; Courtney Kwan, BA; Leticia Montano; Richard Barbers, MD
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University of Southern California, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A1. doi:10.1016/j.chest.2016.02.003
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SESSION TITLE: Asthma and Allergy

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

PURPOSE: Disparities in health care access and outcomes are clearly seen in asthma. Lower socioeconomic status, educational deprivation, and ethnic minority status are linked to noncompliance and poorer disease control; thus a large majority of asthmatic county hospital patients present with severe refractory disease. Bronchial thermoplasty (BT) shows great promise in the treatment of advanced asthma, but is very expensive upfront and thus rarely offered to indigent patients. However, Cangelosi et al recently published a study in commercially-insured patients which suggests that BT is actually quite cost-effective in the long run1. We therefore hypothesize that BT would be equally cost-effective in county hospital settings if the beneficial outcomes can be proven to be similar in these two disparate patient populations.

METHODS: This is a retrospective chart review of BT patients at the Los Angeles County Hospital and the USC Keck Medical Center between 2013-2015. All procedures were performed by one of two bronchoscopists. Inclusion criteria were 1) successful completion of all sessions, and 2) completion of Asthma Control Test (ACT) questionnaires regarding their status before and after the intervention. Patients who have not yet finished treatment or who died were excluded. The pre-BT ACT scores were compared to the post-BT ACT scores, and the degree of improvement was calculated.

RESULTS: Based on paired T-test calculations, the pooled data reconfirmed the findings of the AIR2 trial in regards to improved quality of life after BT, as measured by a statistically significant difference in ACT scores (p<0.0009). In addition, many of these patients had a much lower baseline FEV1 compared to AIR22. Subgroup analysis did not demonstrate any difference between the outcomes in county v.s. private hospital patients.

CONCLUSIONS: BT can be performed safely and effectively in patients with more severe disease than in the AIR2 trial. There is a statistically significant improvement in ACT scores after BT which does not differ based on the patient’s access to health care at a county vs private hospital.

CLINICAL IMPLICATIONS: Bronchial thermoplasty is equally effective in improving quality of life in severe refractory asthmatics regardless of their socioeconomic, educational, and ethnic backgrounds. Based on recent cost-effectiveness data, county hospitals should consider offering BT for the treatment of severe refractory asthma. References Canglosi et al. Expert Rev Pharmacoecon Outcomes Res 2014;15 (2)

DISCLOSURE: Ching-Fei Chang: Consultant fee, speaker bureau, advisory committee, etc.: Less than $5000 in last tax year Edward Hu: Consultant fee, speaker bureau, advisory committee, etc.: Disclosure of amount can be discussed with Dr. Hu Richard Barbers: Consultant fee, speaker bureau, advisory committee, etc.: disclosure of amount can be requested from Dr. Barbers The following authors have nothing to disclose: Courtney Kwan, Leticia Montano

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