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Asthma cost and community burden

Asthma burden

The problem of asthma and severe asthma

Asthma impacts the lives of millions of people around the world, with an estimated 235 million people affected by the disease in some form. 1
Worldwide, the prevalence of clinical asthma is estimated to be 4.3% and is attributed to about 250,000 deaths annually. 2-3Globally between 5 - 10 % of the overall asthma population has been estimated to have severe asthma. 4-5

Total severe asthma costs are estimated to be almost five times more than mild asthma. 6 This is because, compared with mild or moderate asthma patients, severe asthma patients have: 6–8

  • Higher medication usage
  • Higher costs related to physician visits
  • Higher costs related to exacerbations, which are also more frequent
  • A higher likelihood of hospitalisation or emergency department visits

This is partly because the ongoing cost of asthma increases as disease control decreases, so considerable cost savings could be achieved by improving the level of disease control. 9

In a study on 527 asthmatics between 20 and 44 years old, 25% were poorly controlled, but these accounted for 46.2% of the total cost of asthma. In contrast, the 25% with good control of symptoms accounted for 12.4% of the total cost of disease. 7

Asthma cost

The cost of asthma 

Most studies on the burden of asthma are from developed countries, where national surveys of diseases and large, administrative databases, can be interrogated to provide a broad picture of the burden. There is variation within countries and a lack of information from low- and middle-income countries: 10

  • A recent study in the USA estimated that the total cost of asthma to society was $56 billion in 2007, or $3259 per person per year (in 2009 US dollars) 11 
  • A recent Canadian study has shown that, compared with controlled asthma, uncontrolled asthma results in a $184 (in 2012 Canadian dollars) loss of productivity during a week for such a person, 90% of which is attributable to presenteeism (attending work whilst sick and less productive than normal) 12
  • A European study in 2011 estimated the total cost of asthma in that year to be €19.3 billion among Europeans aged from 15 to 64 years (in 2011 Euros) 9

In a separate study in the Asia-Pacific region, the total annual asthma management costs ranged from $193 in well controlled patients to $861 in poorly controlled patients (in 2000 US dollars) 13

Direct and indirect costs of asthma treatment

Direct healthcare costs relate to use of medical resources, such as medication and in- and out-patient services. 14Indirect healthcare costs refer to losses resulting from illness, such as lost productivity at work. 14Both the direct and indirect costs of asthma rise with disease severity. 6915-16Studies have estimated the direct costs of severe asthma to be €2782.45, approximately four times those of mild asthma (€686.31; in 1998 Euros), 16and the indirect costs over six times those of mild asthma. 6

Direct and indirect costs of asthma correlate with severity  

Graph showing in Euros the indirect costs, costs for emergency department/hospitalisation, physician visits and drugs versus asthma severity (GINA 2002 classification).

GINA, Global Initiative for Asthma.
Adapted from Antonicelli, et al. 2004.
 
15

Cost of asthma exacerbations

Asthma exacerbations are associated with a high cost of treatment, especially those resulting in hospitalisation. A US study showed that hospitalisations were responsible for 17% of the overall asthma costs, compared with 4% in mild asthma. 17

In a sample of patients with severe asthma in Brazil, 90.5% had been hospitalised at least once for an asthma exacerbation, with 34% (n=25) having been hospitalised at least once in the previous year. 18Similarly, in a cross-sectional European study, 39.5% (n=64) of patients with severe asthma had been hospitalised for asthma at least once in the previous year. 19

Economic consequences of severe asthma exacerbations

As asthma control decreases, the overall economic costs of asthma increase. This includes work and school time lost, in part due to the need for physician and hospital visits. 920

Economic costs of asthma increase with loss of control (US patients after 24 months’ follow-up)

The economic costs of asthma increase with loss of control of asthma symptoms (US patients after 24 months’ follow-up). ATAQ index score (based on severity of asthma versus cost for medication, emergency department visits, hospital nights, physician visits and work/school days lost).

Figure shows annual costs associated with asthma burden by ATAQ score 24 months after follow-up. ATAQ is a self-administered tool that measures the asthma-related barriers of severity of asthma versus cost for medication, emergency department visits, hospital nights, physician visits and work/school days lost. Zero represents no asthma control problems. Individual burden and total burden costs were significantly different between ATAQ groups (p≤0.0001). 20
ATAQ, Asthma Therapy Assessment Questionnaire.

Reprinted from Sullivan SD, et al. Allergy 2007;62:126–33.Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma. Copyright (2007).

References

  1. World Health Organization. Asthma. WHO Website. Available at: http://www.who.int/mediacentre/factsheets/fs307/en/#. Updated 2013. Last accessed November 2015.
  2. World Health Organisation. Global surveillance, prevention and control of chronic respiratory diseases: A comprehensive approach. 2007. 1–155.
  3. To T, et al.BMC Public Health 2012;12:1–8.
  4. Moore WC, et al. J Allergy Clin Immunol 2007;119:405–13.
  5. Chung KF, et al. Eur Respir J 2014;43:343–73.
  6. Serra-Batlles J, et al. Eur Respir J 1998;12:1322–6.
  7. Accordini S, et al. Int Arch Allergy Immunol 2006;141:189–98.
  8. Kupczyk M, et al. Clin Exp Allergy 2014;44:212–21.
  9. Accordini S, et al. Int Arch Allergy Immunol 2013;160:93–101.
  10. GINA 2016 © 2016 Global Initiative for Asthma, all rights reserved.  Use is by express license from the owner. www.ginasthma.org (Last accessed December 2016).
  11. Barnet SBL, Nurmagambetov TA. J AllergyClin Immunol 2011;127:145–52.
  12. Sadatsafavi M, et al. Chest 2014;145:787–93.
  13. Lai CKW, et al. Eur Respir Rev 2006;15:24–29.
  14. Boccuzzi SJ. Indirect health care costs. In: Weintraub WS (ed) Cardiovascular Health Care Economics. 1st ed. Humana Press, NY, USA: 2003. p63–79.
  15. Antonicelli L, et al. Eur Respir J 2004;23:723–9.
  16. Godard P, et al. Eur Respir J 2002;19:61–7.
  17. Cisternas MG, et al. J Allergy Clin Immunol 2003;111:1212–8.
  18. De Carvalho-Pinto RM, et al. Respir Med 2012;106:47–56.
  19. ENFUMOSA Study Group. Eur Respir J 2003;22:470–7.
  20. Sullivan SD, et al. Allergy 2007;62:126–33.