Impact of inhaled corticosteroids on acute asthma hospitalization in Sweden - 1978 to 1991

OBJECTIVES. In clinical studies, it has been found that treating asthmatic patients with inhaled corticosteroids can reduce the need for in-patient care. The purpose of this study was to determine if such a relationship could be observed in available health-care statistics in Sweden and, if such a relationship could be established, what health economic consequences it implied. METHODS. A retrospective study was conducted using regional data on acute hospitalization-ie, number of bed-days in acute somatic in-patient care clinics-and sales of anti-asthmatic drugs from 14 health-care administrative regions, covering 6 million people (71% of the Swedish population) between 1978 and 1991. The data were analyzed in multiple regression analyses where time- and cross-section data were pooled. The variation in bed-days was explained by three variables: (1) the sales of inhaled corticosteroids, (2) the total 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 asthma in the 14 county councils did not show any upward or downward trend between 1978 and 1985. However, after 1985, there was a significant downward trend despite an increase in estimated asthma prevalence. Increased sales of inhaled corticosteroids were significantly correlated (P < 0.01) with a reduction in bed-days due to asthma. The model used indicated that an increase in sales of inhaled corticosteroids by 1 defined daily dose (DDD) per day and 1,000 inhabitants gave, on average over the study period, a reduction of 1.5 bed-days for asthma in acute 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, seem to be realized in clinical practice. The increased costs of inhaled corticosteroids to the health-care system were more than offset by a reduction in the costs for acute somatic hospital care.