IMPACT OF INHALED CORTICOSTEROIDS ON ACUTE ASTHMA HOSPITALIZATION IN SWEDEN - 1978 TO 1991

OBJECTIVES. In clinical studies, it has been found that treating asthm atic patients with inhaled corticosteroids can reduce the need for in- patient care. The purpose of this study was to determine if such a rel ationship could be observed in available health-care statistics in Swe den and, if such a relationship could be established, what health econ omic consequences it implied. METHODS. A retrospective study was condu cted using regional data on acute hospitalization-ie, number of bed-da ys in acute somatic in-patient care clinics-and sales of anti-asthmati c drugs from 14 health-care administrative regions, covering 6 million people (71% of the Swedish population) between 1978 and 1991. The dat a were analyzed in multiple regression analyses where time- and cross- section data were pooled. The variation in bed-days was explained by t hree variables: (1) the sales of inhaled corticosteroids, (2) the tota l number of bed-days within acute somatic in-patient care, and (3) the sales of inhaled bronchodilators, which were used as a proxy variable for asthma prevalence. RESULTS. The total number of bed-days due to a sthma in the 14 county councils did not show any upward or downward tr end between 1978 and 1985. However, after 1985, there was a significan t downward trend despite an increase in estimated asthma prevalence. I ncreased sales of inhaled corticosteroids were significantly correlate d (P < 0.01) with a reduction in bed-days due to asthma. The model use d indicated that an increase in sales of inhaled corticosteroids by 1 defined daily dose (DDD) per day and 1,000 inhabitants gave, on averag e over the study period, a reduction of 1.5 bed-days for asthma in acu te in-patient care per 1,000 inhabitants. CONCLUSIONS. Clinical trial findings that treating asthmatic patients with inhaled corticosteroids improves asthma control and reduces the need for hospitalization, see m to be realized in clinical practice. The increased costs of inhaled corticosteroids to the health-care system were more than offset by a r eduction in the costs for acute somatic hospital care.