Impact of Inhaled Corticosteroid–Induced Oropharyngeal Adverse Effects on Treatment Patterns and Costs in Asthmatic Patients: Results from a Delphi Panel

Inhaled corticosteroids (ICSs) are associated with rare systemic adverse drug effects (ADEs) but, more commonly, are associated with oropharyngeal ADEs. The objective of this study was to determine the treatment patterns employed by physicians for ICS-induced oropharyngeal ADEs in order to ultimately determine their economic burden. A panel of 15 physicians completed three rounds of a Delphi process to validate the “seeding” algorithm, to assess initial probabilities of the algorithm, and to facilitate consensus on those probabilities. After consensus was achieved, costs were assigned to office visits. The most commonly reported ADE was oral candidiasis (5.6%), followed by cough (5.3%), sore throat (4.8%), and dysphonia (4.1%). The mean number of office visits needed to diagnose and treat cough was 3.4; dysphonia, 3.3 visits; sore throat, 2.5 visits; and oral candidiasis, 1.9 visits. The panel estimated that 26% to 30% of patients required a dose reduction and that 14% to 29% needed to be switched to another ICS. Cough was the most costly ICS-induced ADE ($154 million); oral candidiasis was the least costly ($91 million). The total economic burden for office visits associated with ICS-induced ADEs was approximately $464 million. ICSinduced oropharyngeal ADEs can be associated with a significant economic burden as a result of increased physician time.