OBJECTIVES: Patients with asthma and low levels of type 2 inflammation biomarkers (T2low) have limited effective treatment options and healthcare resource utilization (HCRU) of severe, uncontrolled T2low asthma remains unexplored. We estimated HCRU of T2low and non-T2low patients using real world data.

METHODS: Baseline data were gathered from patients with asthma diagnosis at the pulmonary department of Turku University Hospital, Finland during 2012-2018 (N=9612). Patients with severe asthma were identified based on drug purchase history corresponding to ICS ≥800 µg/day fluticasone propionate equivalent + ≥1 controller (N=1986). Uncontrolled asthma was defined by asthma control test score <20, or ≥1 emergency/acute visits or hospitalization due to asthma (N=637), and T2low by blood eosinophils consistently <300 cells/µl and fractional exhaled nitric oxide <25 ppb during baseline (N=66; vs. non-T2low N=103). Total HCRU, including open care medications and specialty care visits, and comorbidities were evaluated during follow-up 2018-2021. The main drivers for the HCRU were assessed with gamma and negative binomial regression models, using different dependent variables and baseline covariates as independent variables.

RESULTS: HCRU costs were similar in the severe uncontrolled T2low and non-T2low patients. All-cause per patient year (PPY) costs were 8,908€ [95%CI; 6,396€, 11,983€] for T2low and 7,518€ [5,624€, 9,996€] for non-T2low patients, with respiratory specific costs 1,497€ [958€, 2,167€] for T2low and 1,480€ [1,168€, 1,833€] for non-T2low patients. All-cause specialty care PPY costs tended to be higher for T2low patients, consisting of outpatient visits (2,305€ [1,733€, 2,956€] vs 1,907€ [1,475€, 2,439€]), hospitalizations (1,683€ [877€, 2,703€] vs 1,221€ [568€, 2,129€]) and emergency room visits (235€ [135€, 396€] vs. 233€ [171€, 301€]). Regression modeling identified no differences between the groups with similar per patient cumulative costs during the follow-up (≈30-35k€).

CONCLUSIONS: Patients with uncontrolled severe T2low asthma use as much healthcare resources as corresponding non-T2low patients, but with limited treatment options.