Study examines impact of asthma biologics on UNHCR


The research, conducted in Germany, found that biologic treatment of asthma led to reduced healthcare resource utilization (HCRU), as evidenced by fewer hospitalizations and prescriptions for oral corticosteroids, as well as fewer work stoppages.

The benefits of biologics for severe asthma are well known, and seeking to expand on this knowledge, a recently published study examined the impact on healthcare resource utilization (HCRU).

The authors noted that while severe asthma affects a minority of patients, “it increases asthma burden and is associated with high human and economic costs.” Patients who do not respond to standard therapies have more frequent exacerbations and airway obstructions. Additionally, patients with severe asthma who have oral corticosteroids (OCS) added to their regiment for more than a year are at risk for infections, bone and muscle diseases, atrial fibrillation, and hypertension.

Using a large dataset of health insurance records from Germany, researchers compared the HCRU and the associated direct and indirect costs before and after initiation of biologic therapy in biologic-naïve patients during at least 12 months before the start of the study.

The retrospective analysis of real-world claims data focused on adult patients with asthma who started biologic asthma therapy between January 2015 and June 2018.

The researchers used 2 databases which included insurance data for 7.7 million people (8% to 9% of the total German population) on inpatient and outpatient care, including diagnoses, procedures, pharmaceutical and non-pharmaceutical prescriptions and interventions, as well as the associated costs, from January 2014 to June 2019.

Of the nearly 5 million people continuously enrolled for the duration of the study and analyzed, 388,932 patients had a confirmed diagnosis of asthma. They were included on the basis of at least 1 hospital stay or 2 outpatient visits within 365 days or a combination of 2 outpatient visits and at least 1 hospital stay where asthma was the secondary reason for hospitalization within 365 days.

The biologics in the database were omalizumab, mepolizumab, benralizumab, and reslizumab (another biologic, dupilumab, was only approved in Germany in 2019).

During the study period, 571 asthmatic patients started a biological treatment (316 under omalizumab, 232 under mepolizumab, 16 under benralizumab and 7 under reslizumab). The authors noted that the proportion of patients on each product reflects how long each drug has been on the market (ie, omalizumab was the first biologic drug in Germany, in 2005).

At baseline, patients received an average of 2.75 OCS prescriptions, falling to an average of 2.17 over the 3.5-year follow-up period.

Hospitalizations and sick days

Asthma-related hospitalizations, a proxy for severe exacerbations, decreased significantly after initiation of biologic therapy, from 16.99% of patients to 7.18%. The duration of hospitalization for asthma decreased from a mean (SD) of 2.06 (7.25) days to 1.15 (6.81).

Additionally, after starting a biologic, the proportion of patients hospitalized for any reason also decreased significantly from 42.38% to 31.87%, and the average number of days spent in hospital decreased significantly from 6.95 (14.74) to 5.07 (13.92). days per patient.

For sick days, only the result of asthma-specific leave by proportion of patients was statistically significant, with the number using at least 1 sick day increasing from 28.07% to 20.14% (P <.001 however the average number of sick days for any reason was not affected.>

Direct and indirect costs

After starting a biologic drug, overall costs increased due to use of the biologic drug, but hospitalization costs decreased:

  • Mean total costs per patient were $7,185.16 (€6,618.90) at baseline and $24,785.69 (€22,832.33) during follow-up.
  • Hospitalization costs decreased considerably, from 2652.41 US$ (2443.37 €) before the start of biological treatment to 2108.87 US$ (1941.93 €; P
  • Costs per patient during the follow-up period for the biologic drug were $17,632.20 (€16,243.20)

The indirect costs associated with absence from work have also improved considerably.

Among the strengths of the study, the authors cited the fact that the claims data came from different regions of Germany, thus avoiding bias in patient selection or study site. Due to the nature and structure of the German healthcare system, the data was also comprehensive.

The study showed that biologic treatment for severe asthma resulted in fewer hospitalizations, fewer OCS prescriptions and fewer sick days, all indicating better asthma control.

“Biologics were linked to higher costs to healthcare providers in the first year of use,” the authors noted. “Therefore, the short- and long-term clinical benefits and financial burden must be considered within the overall health care context.”


Hardtstock F, Krieger J, Wilke T, et al. Use of biological therapies in the treatment of asthma – a comparative analysis of real-world data on the use of healthcare resources and costs before and after the start of therapy. J Asthma Allergy. Published online April 5, 2022. doi:10.2147/JAA.S354062


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