Effectiveness and Cost of a Comprehensive Severe Asthma Management Strategy Guided by Airway Inflammometry

Objective: To compare hospitalization, annual asthma exacerbation rates (AAER), and estimated healthcare and drug-related costs accrued in the 2 years prior to referral to our centre (2017-2019) and the 2 years of treatment using our strategy (2019-2021). Methods: 257 patient records were reviewed. The treatment strategy, including switching biologics, bronchial thermoplasty, and measures to prevent infection, was guided by sputum measurements and immunophenotyping including sputum autoantibody assays and cytokine measurements, FeNO, airway hyperresponsiveness, airway CT and MR imaging, and immunodeficiency workup. Costs were calculated using the Ontario Schedule of Benefits and Drug Formulary. Results: Overall, mean AAER was reduced from 0.42 to 0.18 and the total number of hospitalizations from 65 to 10. The mean % of reduction of AAER was 85 for the biologics strategy, 70 for the thermoplasty strategy, and 85 for the group of patients whose exacerbations were being driven by infections. However, this was offset by the cost of each treatment strategy (Table 1). Conclusion: Baseline exacerbation rates of severe asthma are low in Ontario reflecting access to effective interventions and the quality of the publicly funded healthcare system. Further reductions and near-total elimination of exacerbations can be achieved by a comprehensive treatment strategy. However, precision medicine incurs significant costs.