Biologic Underutilization and Healthcare Burden in US Patients with Type 2 Severe Asthma.

Background: Detailed real-world evidence on the unmet needs and economic burden of patients with type 2 severe asthma, particularly in the biologic therapy era, remains limited. Purpose: To characterize unmet treatment needs and economic burden in patients with type 2 severe asthma and a history of frequent exacerbations who could benefit from biologic therapy. Patients and Methods: This retrospective cohort study used healthcare claims data from the US Optum's de-identified Clinformatics Results: Overall, 2827 patients met the study definition for type 2 severe asthma (GINA 4: n=1513; GINA 5: n=1314), with 11.9% of patients (GINA 4: 5.2%; GINA 5: 19.6%) receiving biologics at baseline. Systemic/oral steroid-defined exacerbations were most common at baseline and follow-up across GINA steps. Overall, similar proportions of patients at GINA 4 and 5 (71.6% and 70.5%, respectively) experienced ≥1 exacerbation during the follow-up period. The mean (SD) total number of exacerbations was 1.6 (1.8) at GINA 4 versus 1.7 (1.9) at GINA 5. Mean (SD) steroid-defined exacerbations were 1.3 (1.5) versus 1.4 (1.6), emergency-department (ED)-defined exacerbations were 0.2 (0.9) versus 0.2 (0.8), and hospitalization-defined exacerbations were 0.04 (0.3) and 0.06 (0.3) in the respective treatment groups. Patients at GINA step 5 receiving biologic therapies at baseline had lower asthma-related inpatient admissions costs versus those not receiving biologic therapies. Conclusion: Patients with type 2 severe asthma at GINA steps 4/5 experience similar disease burden. These findings highlight a potential unmet need for earlier phenotypic assessment in this population.