Cost and Management of Asthma Exacerbations in Spanish Hospitals (COAX Study in Hospital Services)

The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting β 2 agonists. The mean cost was €1555.70 (95% confidence interval [CI], €1237.60-€1907.00), of which 93.8% (€1460.60; 95% CI, €1152.50-€1779.40) was due to direct costs, and 6.2% (€95.1; 95% CI, €35.5-€177) to indirect costs. Cost rose with increasing severity of the exacerbation—€292.60 for a mild exacerbation, €1230.50 for a moderate exacerbation, and €3543.10 for a severe exacerbation. The mean cost was €1555.70. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting β 2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations. La prevalencia y el gasto sanitario originado por el asma están aumentando progresivamente en los países desarrollados. El 70% del coste total está producido por exacerbaciones. El objetivo principal del estudio fue conocer el coste hospitalario de una crisis asmática en nuestro medio. Como objetivo secundario se quiso conocer cuál era el tratamiento de mantenimiento para el control del asma que utilizaban los pacientes antes de la agudización asmática y su tratamiento. El estudio formaba parte de uno más amplio (COAX II) realizado en 8 países europeos que pretendía los mismos objetivos en cada país. Estudio observacional prospectivo en el que se incluyó a 126 pacientes con crisis asmáti