Economic burden of asthma: a systematic review

Bahadori, Katayoun; Doyle-Waters, Mary M; Marra, Carlo; Lynd, Larry D.; Alasaly, Kadria; Swiston, John; FitzGerald, J. Mark

doi:10.1186/1471-2466-9-24

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Economic burden of asthma: a systematic review

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Author(s): Katayoun Bahadori ¹ , Mary M Doyle-Waters ¹ , Carlo Marra ² , Larry Lynd ² , Kadria Alasaly ³ , John Swiston ⁴ , J Mark FitzGerald ⁴ ^,

Publication date (Electronic): 19 May 2009

Journal: BMC Pulmonary Medicine

Publisher: BioMed Central

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Abstract

Background

Asthma is associated with enormous healthcare expenditures that include both direct and indirect costs. It is also associated with the loss of future potential earnings related to both morbidity and mortality. The objective of the study is to determine the burden of disease costs associated with asthma.

Methods

We performed a systematic search of MEDLINE, EMBASE, CINAHL, CDSR, OHE-HEED, and Web of Science Databases between 1966 and 2008.

Results

Sixty-eight studies met the inclusion criteria. Hospitalization and medications were found to be the most important cost driver of direct costs. Work and school loss accounted for the greatest percentage of indirect costs. The cost of asthma was correlated with comorbidities, age, and disease severity.

Conclusion

Despite the availability of effective preventive therapy, costs associated with asthma are increasing. Strategies including education of patients and physicians, and regular follow-up are required to reduce the economic burden of asthma.

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Most cited references 71

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An economic evaluation of asthma in the United States.

Simon T Hodgson, P Gergen, Shelly K Weiss (1992)

Asthma is a common chronic illness. Recently, increases in morbidity and mortality due to this disease have been reported. We studied the distribution of health care resources used for asthma in order to lay the groundwork for further policy decisions aimed at reducing the economic burden of this disorder. Estimates of direct medical expenditures and indirect costs (in 1985 dollars) were derived from data available from the National Center for Health Statistics. These cost estimates were projected to 1990 dollars. The cost of illness related to asthma in 1990 was estimated to be $6.2 billion. Inpatient hospital services represented the largest single direct medical expenditure for this chronic condition, approaching $1.6 billion. The value of reduced productivity due to loss of school days represented the largest single indirect cost, approaching $1 billion in 1990. Although asthma is often considered to be a mild chronic illness treatable with ambulatory care, we found that 43 percent of its economic impact was associated with emergency room use, hospitalization, and death. Nearly two thirds of the visits for ambulatory care were to physicians in three primary care specialties--pediatrics, family medicine or general practice, and internal medicine. Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.

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A national estimate of the economic costs of asthma.

Fergal Malone, Norihiko Okamoto, Ian Saunders … (1997)

This cost of illness analysis examines national cost and resource utilization by persons with asthma using a single, comprehensive data source, the 1987 National Medical Expenditure Survey. Direct medical expenditures included payments for ambulatory care visits, hospital outpatient services, hospital inpatient stays, emergency department visits, physician and facility payments, and prescribed medicines. Indirect medical costs included costs resulting from missed work or school and days with restricted activity at work. Point estimates and 95% confidence intervals (CI) were calculated and inflated to 1994 dollars. The total estimated cost was $5.8 billion (95% CI, $3.6 to $8 billion). The estimated direct expenditures were $5.1 billion (95% CI, $3.3 to $7.0 billion), and indirect expenditures were valued at $673 million (95% CI, $271 to $1,076 million). Hospitalization accounted for more than half of all expenditures. More than 80% of resources were used by 20% of the population (defined as 'high-cost patients'). The estimated annual per patient cost for those high-cost patients was $2,584, in contrast with $140 for the rest of the sample. Findings from this study indicate that future asthma research and intervention efforts directed at hospitalizations and high-cost patients could help to decrease health care resource use and provide cost savings.

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Trends in the cost of illness for asthma in the United States, 1985-1994.

K B Weiss, S D Sullivan, C S Lyttle (2000)

During the past decade, there have been notable changes in asthma prevalence, morbidity, and mortality. In this same time period, there have also been important national efforts to increase asthma awareness and improve asthma care. The purpose of this study was to examine the changes in US cost of illness for asthma during the 10-year period from 1985-1994. The study was a two-period (1985 and 1994), cross-sectional, cost-of-illness analysis. Cost estimates were based on US population and health care survey data available from the National Center for Health Statistics. The total US costs of asthma for 1994 were $10.7 billion. On the basis of 1985 estimates adjusted to 1994 dollars, total asthma costs increased by 54.1% and direct medical expenditures increased by 20.4% during the 10-year period. In 1985, hospital inpatient care represented the largest component cost of direct medical expenditures (44.6%). Hospital inpatient costs decreased to 29.5% of direct medical expenditures in 1994, primarily because of shorter lengths of stay, as opposed to a decrease in the total number of admissions. In 1994, medications represented the largest component cost of direct medical expenditures (40.1%, up from 30.0% in 1985). The largest component increase in indirect costs was due to loss of work. On the basis of adjusted dollars, estimated costs per affected person with asthma declined by 3.4% (decrease of 15.5% for children and an increase of 2.9% for persons 18 years and older) during this time period. Although the US costs of asthma increased during the 1985-1994 time period, estimated costs per person with asthma demonstrated a modest decline. These findings may represent a combination of reductions in hospital lengths of stay and increasing prevalence of persons with low consumption of asthma-related health care resources. In examining the component costs, it is unclear whether these changes can be attributed to the many local, regional, and national efforts aimed at controlling untoward asthma outcomes during the 1985-1994 time period.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Pulm Med

Title: BMC Pulmonary Medicine

Publisher: BioMed Central

ISSN (Electronic): 1471-2466

Publication date Collection: 2009

Publication date (Electronic): 19 May 2009

Volume: 9

Page: 24

Affiliations

[1 ]Centre for Clinical Epidemiology & Evaluation (C2E2), UBC, Vancouver, BC, Canada

[2 ]Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada

[3 ]British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada

[4 ]Department of Medicine, Respiratory Division, UBC, Vancouver, BC, Canada

Article

Publisher ID: 1471-2466-9-24

DOI: 10.1186/1471-2466-9-24

PMC ID: 2698859

PubMed ID: 19454036

SO-VID: 224f2273-9970-4f81-90ae-968f251b8003

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 12 November 2008

Date accepted : 19 May 2009

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Economic burden of asthma: a systematic review

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Abstract

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Most cited references 71

An economic evaluation of asthma in the United States.

A national estimate of the economic costs of asthma.

Trends in the cost of illness for asthma in the United States, 1985-1994.

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