Economic burden of short-acting beta-2 agonist (SABA) overuse among asthma patients in Türkiye: a cost analysis with respect to the updated GINA treatment recommendations
Authors: Yorgancıoğlu Arzu , Aksu Kurtuluş , Cura Ceyhun , Yaman Yiğit , Dinç Melda , Malhan Simten ,   the SABINA Türkiye Study Group*, Kızılırmak Deniz , Altıntaş Nejat , Bulut İsmet , Çağatay Tülin , Gemicioğlu Bilun , İnce Özgür , Oğuzülgen Kıvılcım , Mungan Dilşad , Kalpaklıoğlu Füsun , Baççıoğlu Ayşe , Aksu Funda , Altuntaş Murat , Erkekol Ferda Öner , Karakaya Gül , Kalyoncu Ali Fuat , Damadoğlu Ebru , Hanta İsmail , Altunok Ersoy , Özer Adviye , Naycı Sibel Atış , Yuluğ Demet Polat , Gülbaş Gazi , Süerdem Mecit , Yormaz Burcu , Ceylan Emel , Erge Duygu , Çilli Aykut , Doğan Berat Celil , Erel Fuat , Sevinç Can , Anar Ceyda , Ediger Dane , Pekbak Gülseren , Erbay Müge 
Published: October 2024

Abstract
Background
This cost of illness study aimed to determine economic burden of short-acting β2-agonist (SABA) overuse in Türkiye from payer perspective with respect to the updated GINA 2022 treatment recommendations.

Methods
A total of 3,034,879 asthma patients comprised the study population, via estimations extrapolated from the Türkiye arm of the global SABINA III study. The economic burden (costs related to the drug use and severe exacerbations) was compared in subgroups of overall (≥ 0 canisters/year) vs. GINA-recommended (0–2 canisters/year, hypothetical population) SABA use and in subgroups of appropriate use (0–2 canisters/year, real population) vs. overuse (≥ 3 canisters/year) of SABA with extrapolation of SABINA Türkiye data to the Türkiye asthma population.

Results
Recommended SABA use was predicted to prevent 127,505 of 157,512 severe exacerbations per year in mild asthma patients and 2,668,916 of 3,262,800 severe exacerbations per year in moderate-severe asthma patients. Annual cost burden of not applying recommended SABA use (overall [≥ 0 canisters/year] vs. GINA-recommended [0–2 canisters/year] SABA use) in mild asthma and moderate-severe asthma patients was calculated to be €20.43 million and €427.65 million in terms of severe exacerbations, and to be €829,352 and €7.20 million in terms of drug costs, respectively. The total annual economic burden arising from not applying recommended SABA use was estimated to be €456.11 million. Appropriate use (0–2 canisters/year) vs. overuse (≥ 3 canisters/year) of SABA was associated with decreased frequency of severe exacerbations per year in mild asthma (from 129,878 to 27,634) and moderate-severe asthma (from 2,834,611 to 428,189) patients. SABA overuse in mild and moderate-severe asthma patients was estimated to yield an additional annual cost of €16.38 million and €385.59 million, respectively in terms of severe exacerbations, and a total €11.30 million additional drug cost. The overall annual economic burden arising from SABA overuse was estimated to be €413.27 million.

Conclusions
The estimated annual total economic burden arising from not applying recommended SABA use (€456.11 million) and SABA overuse (€413.27 million) with respect to the updated GINA 2022 treatment recommendations indicates the substantial cost burden of SABA overuse to the Turkish National Health System, corresponding up to 26% of the total direct cost of asthma reported in our country.