Asthma treatment in primary care : studies of variability and health economic aspects

Background: Most asthma patients in Sweden are treated in primary care, but little is known about economic aspects of asthma treatment in that setting and about the regional variation in the use of antiasthmatics drugs and the adherence to national guidelines for the treatment of asthma.

General aims: To analyze treatment of asthma patients in terms of classification of severity, quality of life, variation in utilization, clinical practice and costs from a societal perspective.

Methods: A prospective cross-sectional design was used to study the pharmaceutical costs of asthma and their relationship to quality of life, asthma severity, clinical practice and lungfunction and to compare different approaches to classifying asthma severity, all in primary care. A prospective cluster-randomized controlled trial was carried out in primary care to study the effect of information and monitoring on asthma control. To study regional variations in antiasthmatics, a registry study based on the Swedish National Prescribed Drug Register was performed. In all studies, the population consists of adult patients. However, in the registry study, there was an upper limit of 44 years of age to exclude patients with COPD-patients.

Results and conclusions: There are large variations in costs of pharmaceuticals for asthma treatment between primary care centers in Stockholm as well as between different Swedish regions. Asthma severity explains only a small part of the variations in pharmaceutical costs and does not account for the differences between centers. When different approaches used to classify severity were tested, no strategy tested strategies was superior. Adherence to guidelines is low among caregivers. There is room for improvement of both asthma control and quality of life of asthma patients treated in primary care. Adding structured information and monitoring by diary can improve the patient s outcome.

List of scientific papers

I. Arnlind MH, Nokela M, Rehnberg C, Jonsson EW. (2006). The relationship between pharmaceutical costs, disease severity, and health-related quality of life in asthmatics in Swedish primary care. J Asthma. 43(8):585-91.
https://doi.org/10.1080/02770900600878305

II. Arnlind Heibert M, Nokela M, Wikström Jonsson E. (2009). Asthma Severity in Primary Care Asthmatics: A comparative study of different approaches to classification of severity. Primary Care Respiratory Journal. [Accepted]
https://doi.org/10.4104/pcrj.2010.00046

III. Nokela M, Arnlind Heibert M, Ehrs P-O, Krakau I, Forslund L, Wikström Jonsson E. (2009). The influence of information and monitoring on treatment outcome in primary care treated asthma: a cluster randomized study. [Submitted]

IV. Arnlind Heibert M, Wettermark B, Hjemdahl P, Nokela M, Rehnberg C, Wikström Jonsson E. (2009). Regional variation and adherence to guidelines for drug treatment of asthma. [Manuscript]