Healthcare costs of asthma comorbidities: a systematic review protocol

1 Fe kh KE, e al. BMJ Open 2017;7:e015102. doi:10.1136/bmjopen-2016-015102 Open Access Abs Ac In oduc ion As hma is associa ed wi h many como bid condi ions ha ha e he po en ial o impac on i s managemen , con ol and ou comes. These como bid condi ions ha e he po en ial o impac on heal hca e expendi u e. We plan o unde ake a sys ema ic e iew o syn hesise he e idence on he heal hca e cos s associa ed wi h as hma como bidi y. Me hods and analysis We will sys ema ically sea ch he ollowing elec onic da abases be ween Janua y 2000 and Janua y 2017: Na ional Heal h Se ice (NHS) Economic E alua ion Da abase, Google Schola , Allied and Complemen a y Medicine Da abase (AMED), Global Heal h, PsychINFO, Medline, Embase, Ins i u e o Scien i ic In o ma ion Web o Science and Cumula i e Index o Nu sing and Allied Heal h Li e a u e. We will sea ch he e e ences in he iden i ied s udies o addi ional po en ial pape s. Addi ional li e a u e will be iden i ied by con ac ing expe s in he ield and h ough sea ching o egis e s o ongoing s udies. The e iew will include cos -e ec i eness and economic modelling/e alua ion s udies and analy ical obse a ional epidemiology s udies ha ha e in es iga ed he heal hca e cos s o as hma como bidi y. Two e iewe s will independen ly sc een s udies and ex ac ele an da a om included s udies. Me hodological quali y o epidemiological s udies will be assessed using he E ec i e Public Heal h P ac ice P ojec ool, while ha o economic e alua ion s udies will be assessed using he D ummond checklis . This p o ocol has been published in In e na ional P ospec i e Regis e o Sys ema ic Re iews (PROSPERO) da abase (No. CRD42016051005). E hics and dissemina ion As he e a e no p ima y da a collec ed, o mal NHS e hical e iew is no necessa y. The indings o his sys ema ic e iew will be dissemina ed in a pee - e iewed jou nal and p esen ed a ele an con e ences. PROSPERO egis a ion numbe CRD42016051005. In oduc Ion As hma is a highly p e alen condi ion ha is he eason behind many mo bidi y and mo ali y cases in he wo ld.1 2 As hma managemen and con ol can be in luenced, among o he hings, by he p esence o o he como bid condi ions.3–7 Ou ecen ly comple ed scoping e iew in es iga ing he p e alence o como bidi ies among pa ien s wi h as hma iden i ied a numbe o condi ions including, bu no limi ed o dep ession, anxie y, hini is, gas o-oesophageal e lux disease (GORD) and obesi y, may occu mo e equen ly in people wi h as hma han in hose wi hou , leading o po en ial addi ional di icul ies in as hma managemen .8–10 I has been shown ha heal h- ela ed quali y o li e and daily-li e unc ionali y a e diminished, and he use o heal hca e se ices is inc eased wi h he p esence o como bid condi- ions.3 6 9–15 In addi ion, o he s udies showed ha con olling hese condi ions a an ea ly s age may imp o e as hma ou comes.6 12 14 15 These in e na ional s udies ocused on di e en s udy samples who had di e en como bid condi ions, explaining he disc epancies in hei indings.16–18 While hese ha e now assessed he heal hca e and economic bu den associa ed wi h as hma como bidi y,19–21 he e has hi he o been no sys ema ic a emp o syn hesise and summa ise he e idence ha has emana ed om exis ing s udies. This e iew builds on ou ea lie wo k,8 which in ol ed a scoping e iew o he ecen landscape o as hma como bidi y; he pu pose o he cu en wo k is o iden i y, app aise and syn hesise he e idence on heal hca e cos s associa ed wi h as hma como bidi y.19–21 Heal hca e cos s o as hma como bidi ies: a sys ema ic e iew p o ocol Ka im El Fe kh,1 B igh I Nwa u,1,2 Ch is G i i hs,3 Ani a Pa el,3 Aziz Sheikh1 o ci e: Fe khKE, Nwa uBI, G i i hsC, e al. Heal hca e cos s o as hma como bidi ies: a sys ema ic e iew p o ocol. BMJ Open 2017;7:e015102. doi:10.1136/ bmjopen-2016-015102 ►P epublica ion his o y and addi ional ma e ial o his pape a e a ailable online. To iew hese iles please isi he jou nal online (h p:// dx. doi. o g/ 10. 1136/ bmjopen- 2016- 015102). Recei ed 8 No embe 2016 Re ised 25 Janua y 2017 Accep ed 27 Feb ua y 2017 1As hma UK Cen e o Applied Resea ch, Cen e o Medical In o ma ics, Ushe Ins i u e o Popula ion Heal h Sciences, The Uni e si y o Edinbu gh, Edinbu gh, UK 2School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland 3Cen e o P ima y Ca e and Public Heal h, Bliza d Ins i u e, Queen Ma y Uni e si y o London, London, UK Co espondence o Ka im El Fe kh; k. i ikh@ ed. ac. uk P o ocol S eng hs and limi a ions o his s udy ►This is he i s sys ema ic e iew o syn hesise he e idence on he heal hca e cos s a ibu able o as hma como bidi y. ►A majo limi a ion is ha i may be di icul o employ me a-analysis as we an icipa e s udies wi h di e en s udy designs, de ini ions o cos s and ime pe iods. ►Based on p e ious wo k, we an icipa e conside able di icul ies in iden i ying in o ma ion on he indi ec cos s associa ed wi h as hma como bidi ies such as p oduc i i y loss and social and in angible cos s. This e iew will he e o e be ocused on di ec heal hca e cos s only, we ecognise ha i is a subse o o e all cos s. g oup.bmj.com on Sep embe 5, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om 2Fe kh KE, e al. BMJ Open 2017;7:e015102. doi:10.1136/bmjopen-2016-015102 Open Access Me hods This p o ocol has been p epa ed ollowing he P e e ed Repo ing I ems o Sys ema ic e iew and Me a-Analysis P o ocols (PRISMA-P) app oach.22 I has been published in In e na ional P ospec i e Regis e o Sys ema ic Re iews da abase (no CRD42016051005). ypes o s udies We will include economic modelling/e alua ion and analy ical epidemiological s udies— ha is, coho , case-con ol and c oss-sec ional s udies— ha ha e in es- iga ed he heal hca e cos s o as hma como bidi y. Edi o ials, animal s udies, e iews, case s udies,and case-se ies s udies will be excluded. Pa icipan s We a e in e es ed in s udies on pa icipan s wi h e idence o clinician-diagnosed as hma. The e will be no es ic- ion conce ning age o sex o pa icipan s. como bidi ies o in e es Como bidi y has been de ined as ‘any dis inc addi ional clinical en i y ha has exis ed o may occu du ing he clinical cou se o a pa ien who has he index disease unde s udy’.23 We a e in e es ed in como bidi ies ha a e no ela ed o na u al causes such as ageing, bu a he hose ha a e pa hophysiologically ela ed o as hma and ha e he po en ial o impac on as hma con ol, managemen and/o p ognosis, ega dless o whe he hey de elop be o e o a e as hma. These include, bu a e no limi ed o alle gic diseases, ch onic obs uc i e pulmona y disease, au oimmune diso de s (eg, ype 1 diabe es), me abolic diso de s (eg, ype 2 diabe es, obesi y), ca dio ascula diseases, psychological dys unc- ion (anxie y, dep ession), hype ension and GORD. We g ouped como bidi ies acco ding o he la es e sion o he In e na ional Classi ica ion o Diseases 10 h Re ision diagnosis codes.24 ou come Heal hca e cos s o as hma como bidi ies. sea ch me hods Da abases We will sea ch o published s udies, om 2007 o 2017, om he ollowing da abases: Na ional Heal h Se ice Economic E alua ion Da abase, Google Schola , Allied and Complemen a y Medicine Da abase, Global Heal h, Medline, Embase, Ins i u e o Scien i ic In o ma ion (ISI) Web o Science, Cumula i e Index o Nu sing and Allied Heal h Li e a u e and PsychINFO. Addi ional li e - a u e will be iden i ied by sea ching he e e ence lis o iden i ied eligible s udies and by sea ching he eposi o- ies o in e na ional con e ence p oceedings, including ISI Con e ence P oceeding Ci a ion Index and Ze oc (B i ish Lib a y). We will sea ch he e e ences in he iden i ied s udies o addi ional po en ial pape s. Addi- ional li e a u e will be iden i ied by con ac ing expe s in he ield and h ough sea ching o egis e s o ongoing s udies. Sea ch s a egy We ha e de eloped a s a egy in Medline (see online supplemen a y appendix) o e ie e ele an li e - a u e on he opic. This sea ch s a egy will be adap ed in sea ching o he da abases. The e will be no language es ic ion and, whe e possible, s udies in languages o he han English will be ansla ed. The da abases will be sea ched o he pe iod Janua y 2000 o Janua y 2017. We ha e chosen 2000 as a s a da e while we a e awa e ha he e was limi ed wo k be o e he 2000s on he heal hca e and economic bu den o as hma,25 hese s udies ocused exclusi ely on as hma wi hou aking any como bid condi ions in o conside - a ion. S udy selec ion The a icles e ie ed om he da abase sea ches will be expo ed in o EndNo e e e ence managemen p og amme. Sc eening will be unde aken acco ding o he inclusion and exclusion c i e ia. Two e iewe s (KF and EV) will independen ly unde ake he sc eening o he eco ds (by i le and/o abs ac ) o eligibili y and a hi d e iewe (BN o AS o AP) will a bi a e in case o any disag eemen o each a consensus. Full ex o eligible pape s a e he i s sc eening will be e iewed again o con i m ha he pape s mee he inclusion and exclusion c i e ia. The sc eening p ocess will be unde aken and epo ed acco ding o he PRISMA ecommenda ion.26 Da a ex ac ion A cus omised da a ex ac ion o m is being cons uc ed o ex ac ele an da a om all s udies mee ing ou inclusion c i e ia. The o m will i s be pilo ed on ew s udies i s . The da a abs ac ed will include: au ho (s), publica ion yea , geog aphical loca ion o da a collec ion, s udy design, aims and esea ch ques ions, se ings, popu- la ion/pa icipan s (n, mean age, gende ), como bidi ies s udied, ime pe iod speci ic cos s included, cos uni (s) and es ima es o o al cos s, cu ency, p ice yea , whe he discoun ing was applied whe e ele an and key indings. Da a ex ac ion will be unde aken independen ly by wo e iewe s (KF and EV). Any di e ences will be esol ed by discussion o i necessa y a bi a ion by a hi d e iewe (BN o AS o AP). da a assessmen and syn hesis Quali y assessmen Two e iewe s (KF and EV) will independen ly assess he quali y o included s udies and he po en ial o isk o bias will be e alua ed. We will use he D ummond check- lis 27 o assessing he me hodological quali y o economic e alua ion and cos s udies. Al hough he e a e many economic e alua ion and epo ing checklis s, a lo o hem ha e o e lapping aspec s. The D ummond check- lis ocuses on he quali y o he designs. Consensus will g oup.bmj.com on Sep embe 5, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om 3 Fe kh KE, e al. BMJ Open 2017;7:e015102. doi:10.1136/bmjopen-2016-015102 Open Access be eached h ough discussion and a bi a ion by a hi d e iewe (BN o AS o AP) in e en o any disag eemen . The quali y o he b oade s udy design will be e alu- a ed using he E ec i e Public Heal h P ac ice P ojec (EPHHP) ool.28 The EPHPP ool assesses di e en componen s o s udies: design, biases and me hods. The o e all s udy a ing will be judged as s ong, mode a e o weak based on he componen a ings. Da a syn hesis We an icipa e conside able me hodological and s a is ical he e ogenei y ac oss s udies, which will make i ha d o conduc me a-analyses o he e idence base. A na a i e syn hesis will hus be employed as he p ima y app oach o syn hesise he da a, bu we will also conside he possi- bili y o me a-analysis using andom-e ec s modelling i he da a allow. I ha is he case, hen we will e alua e po en ial o publica ion bias using unnel plo s and Begg and Egge es s.29 30 Subg oup analysis Whe e possible, we will conduc subg oup analyses based on he ca ego ies o ele an sociodemog aphic cha ac- e is ics epo ed in he s udies, pa icula ly by age g oups and gende . ►Age (will depend on how au ho s ha e epo ed i , bu may include ca ego isa ion as ollows): ►Child en and young people <18 yea s ►Adul s (≥18 yea s old) ►Gende ►Male ►Female I he numbe o s udies and da a a ailable show signi ican s a is ical he e ogenei y, hen we will conduc sensi i i y analyses wi h ega ds o s udy quali y by excluding s udies a high isk o bias. conclusIon As hma como bidi ies ha e he po en ial o impac on as hma managemen , heal hca e use and ou comes. We an icipa e ha his sys ema ic e iew will build on ou p e ious wo k on he epidemiology and ou comes o as hma8 31 32 and p o ide impo an insigh s in o pa e ns o as hma como bidi y and he economic consequences o heal h sys ems o hese como bid diso de s. Con ibu o s All au ho s made subs an i e in ellec ual con ibu ions o he de elopmen o his p o ocol. KEF w o e his p o ocol. AS, AP, CG and BIN commen ed c i ically on se e al d a s o he manusc ip . KEF, AS, AP and BIN we e in ol ed in concep ualising his e iew. Funding This wo k is suppo ed by he Chie Scien is ’s O ice o he Sco ish Go e nmen and As hma UK as pa o he As hma UK Cen e o Applied Resea ch (AUK-AC-2012-01). BIN and AS a e suppo ed by he Fa Ins i u e and As hma UK Cen e o Applied Resea ch. Compe ing in e es s None decla ed. P o enance and pee e iew No commissioned; ex e nally pee e iewed. Open Access This is an Open Access a icle dis ibu ed in acco dance wi h he C ea i e Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license, which pe mi s o he s o dis ibu e, emix, adap , build upon his wo k non-comme cially, and license hei de i a i e wo ks on di e en e ms, p o ided he o iginal wo k is p ope ly ci ed and he use is non-comme cial. See: h p:// c ea i ecommons. o g/ licenses/ by- nc/ 4.0/ © A icle au ho (s) (o hei employe (s) unless o he wise s a ed in he ex o he a icle) 2017. All igh s ese ed. No comme cial use is pe mi ed unless o he wise exp essly g an ed. e e ences 1. Bousque J, Knani J, Dhi e H, e al. Quali y o li e in as hma. I. In e nal consis ency and alidi y o he SF-36 ques ionnai e. Am J Respi C i Ca e Med 1994;149:371–5. 2. Riccioni G, D'O azio N, Di Ilio C, e al. Quali y o Li e and clinical symp oms in as hma ic subjec s. J As hma 2004;41:85–9. 3. Adams RJ, Wilson DH, Taylo AW, e al. 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Bu den o alle gic disease in he UK: seconda y analyses o na ional da abases. Clin Exp Alle gy 2004;34:520–6. g oup.bmj.com on Sep embe 5, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om sys ema ic e iew p o ocol Heal hca e cos s o as hma como bidi ies: a Sheikh Ka im El Fe kh, B igh I Nwa u, Ch is G i i hs, Ani a Pa el and Aziz doi: 10.1136/bmjopen-2016-015102 2017 7: BMJ Open h p://bmjopen.bmj.com/con en /7/5/e015102 Upda ed in o ma ion and se ices can be ound a : These include: Re e ences #BIBLh p://bmjopen.bmj.com/con en /7/5/e015102 This a icle ci es 30 a icles, 3 o which you can access o ee a : Open Access h p://c ea i ecommons.o g/licenses/by-nc/4.0/non-comme cial. See: p o ided he o iginal wo k is p ope ly ci ed and he use is non-comme cially, and license hei de i a i e wo ks on di e en e ms, pe mi s o he s o dis ibu e, emix, adap , build upon his wo k Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license, which This is an Open Access a icle dis ibu ed in acco dance wi h he C ea i e se ice Email ale ing box a he op igh co ne o he online a icle. Recei e ee email ale s when new a icles ci e his a icle. Sign up in he Collec ions Topic A icles on simila opics can be ound in he ollowing collec ions (349)Respi a o y medicine No es h p://g oup.bmj.com/g oup/ igh s-licensing/pe missions To eques pe missions go o: h p://jou nals.bmj.com/cgi/ ep in o m To o de ep in s go o: h p://g oup.bmj.com/subsc ibe/ To subsc ibe o BMJ go o: g oup.bmj.com on Sep embe 5, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om