Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

Herrera, A.M.; Brand, P.; Cavada, G.; Koppmann, A.; Rivas, M.; Mackenney, J.; Sepúlveda, H.; Wevar, M.E.; Cruzat, L.; Soto, S.; Pérez, M.A.; León, A.; Contreras, I.; Alvarez, C.; Walker, B.; Flores, C.; Lezana, V.; Garrido, C.; Herrera, M.E.; Rojas, A.; Andrades, C.; Chala, E.; Martínez, R.A.; Vega, M.; Perillán, J.A.; Seguel, H.; Przybyzsweski, I.

OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16–0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010–0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.