OBJECTIVES: We aimed to analyze healthcare utilization types and direct medical costs of asthma exacerbations, and exacerbation-related death of severe asthma patients in South Korea.

METHODS: This study was conducted using the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2016 and 2020. Patients aged ≥10 years were included in the study. Severe asthma was defined as satisfying all following criteria based on Global Initiative for Asthma (GINA) guideline: (1) ≥1 claim of asthma diagnosis (ICD-10: J45-46); (2) ≥1 claim of inhaled corticosteroid (ICS) or ICS/long-acting β2-agonist (LABA); (3) ≥2 exacerbations requiring systemic corticosteroids or ≥1 exacerbation requiring emergency department (ED) visit or hospitalization. Types of exacerbations were classified into four healthcare utilizations: outpatient visit, ED visit, general ward hospitalization, and intensive care unit (ICU) admission. Medical costs driven by asthma exacerbations were calculated as the sum of total medical costs incurred during exacerbation episodes. To identify death attributable to exacerbation requiring hospitalization, the 28-day case fatality rate was calculated.

RESULTS: Overall, 293 patients were included in the study. For types of exacerbations, general ward hospitalization accounted for 46.9%, followed by outpatient visit (45.4%), ICU admission (5.9%), and ED visit (1.7%). Out of total hospitalization, general ward hospitalization and ICU admission accounted for 88.8% and 11.2%, respectively. Medical costs per episode were as follows: outpatient visit, 68,615 Korean won (KRW); ED visit, 168,235 KRW; general ward hospitalization, 2,232,799 KRW; and ICU admission, 11,147,146 KRW. The 28-day case fatality rate was 2.3% and 14.3% for exacerbations requiring general ward hospitalization and ICU admission, respectively.

CONCLUSIONS: In considering medical costs of exacerbations and case fatality rates, clinical and economic burden of severe asthma was found to be substantial in South Korea. Effective strategies for managing patients and optimal treatment options are needed to alleviate the burden of severe asthma patients.