Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1-yr retrospective study.

The purpose of this study was to evaluate the cost of illness of moderate-to-severe atopic asthma and/or seasonal allergic rhinitis (SAR) in Germany from the perspective of third-party payers (TPP) and patients. Five-hundred patients (276 children/adolescents) with moderate-to-severe asthma and/or SAR were included in this cross-sectional study. Information was collected using a specific patient questionnaire and the abstraction of patient records. Overall, annual costs per patient increased with the severity of atopic asthma and if it was associated with SAR. The average annual cost of SAR was Euro1,089 per child/adolescent and Euro1,543 per adult. Annual costs of severe asthma plus SAR increased to Euro7,928 per child/adolescent and to Euro9,287 per adult. For TPPs, the main cost drivers were medication, hospitalisation, and rehabilitation. The most significant costs for patients were household modifications. For children/adolescents, 60-78% of the expenditures were direct costs, while in adults, 58% of expenditures were indirect costs. It was also observed that patients with moderate and severe asthma used inhaled corticosteroids less frequently than recommended by treatment guidelines. In summary, the total cost for patients increases with the severity of atopic asthma and/or seasonal allergic rhinitis and indirect costs represent a large proportion of the total cost.     

Inpatient resource utilisation in younger (2-5 yrs) and older (6-14 yrs) asthmatic children in Finland.

Asthma is the most common chronic disorder among Finnish children, however, the economic burden of paediatric asthma in Finland has not yet been comprehensively evaluated. The objective of this study was to compare inpatient resource utilisation between younger (2-5 yrs) and older children (6-14 yrs) with asthma in Finland. A national database of inpatient resource utilisation was applied to determine use of hospital services among children with asthma in 1999. Regional estimates of charges were combined with hospitalisation episodes to determine total inpatient cost. The results indicate that younger asthmatic children consume 3-times more inpatient resources per capita. Incidence of first admissions because of asthma was 3-times higher in younger children. Hospitalisation and rehospitalisation rates were also 3- and 4-times higher, respectively. The total annual inpatient cost of asthma in children aged 2-5 and 6-14 yrs was Euro 1.98 million with each group accounting for Euro 1.12 million and Euro 0.86 million, respectively. Regional and age-related differences in hospitalisation rates and costs were likely related to variable clinical practice on the primary level, difficulties with diagnosis and compliance among younger children.     

Economic burden of asthma in Korea

Understanding the magnitude of the economic impact of an illness on society is fundamental to planning and implementing relevant policies. South Korea operates a compulsory universal health insurance system providing favorable conditions for evaluating the nationwide economic burden of illnesses. The aim of this study was to estimate the economic costs of asthma imposed on Korean society. The Korean National Health Insurance claims database was used for determining the health care services provided to asthma patients defined as having at least one inpatient or outpatient claim(s) with a primary diagnosis of asthma in 2008. Both direct and indirect costs were included. Direct costs were those associated directly with treatment, medication, and transportation. Indirect costs were assessed in terms of the loss of productivity in asthma patients and their caregivers and consisted of morbidity cost, mortality cost, and caregivers' time cost. The estimated cost for 2,273,290 asthma patients in 2008 was $831 million, with an average per capita cost of $336. Among the cost components, outpatient and medication costs represented the largest cost burden. Although the costs for children accounted for the largest proportion of the total cost, the per capita cost was highest among patients ≥50 years old. The economic burden of asthma in Korea is considerable. Considering that the burden will increase with the rising prevalence, implementation of effective national prevention approaches aimed at the appropriate target populations is imperative.     

Co‐morbidities in severe asthma: Clinical impact and management

Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co‐morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co‐morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co‐morbidity. Finally, the review links co‐morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co‐morbidities to look for in specific patients.     

Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark – Cost‐effectiveness analysis based on five randomised controlled trials

Background and Aims: Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART®) is an effective asthma‐management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations. The aim of this study was to determine the cost‐effectiveness of the Symbicort SMART® regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long‐acting β₂‐agonist (ICS/LABA) combination therapy plus reliever medication or higher dose of inhaled ICS/LABA combination therapy plus reliever medication. Methods: The cost‐effectiveness analyses were based on effectiveness and resource utilisation data, which were prospectively collected during the treatment period in five randomised clinical trials (duration: 24 weeks, 26 weeks or 1 year). Economic analyses were conducted from both a health care sector (direct costs) and a societal perspective [total costs, i.e direct costs + indirect costs (sick leave)]. The time horizon for the economic analyses was 1 year. The effectiveness measure used was the number of avoided severe exacerbations per patient per year. Results: Patients treated with budesonide/formoterol maintenance and reliever therapy showed statistically significant fewer severe exacerbations per patient compared with the alternative treatment regimes in all comparisons. Budesonide/formoterol maintenance and reliever therapy was a dominant treatment option when compared with higher dose ICS or higher dose ICS/LABA, i.e. it was more effective at a lower total cost. In two of the three comparisons with a similar ICS/LABA dose, Symbicort SMART® was dominant. Conclusion: Cost‐effectiveness analyses of budesonide/formoterol maintenance and reliever therapy show that the significant reduction in the number of severe exacerbations observed in all the included clinical studies is predominately obtained at lower costs compared with alternative treatment regimes. This indicates that budesonide/formoterol maintenance and reliever therapy is a cost‐effective treatment option in a Danish setting. Please cite this paper as: Wickstrøm J, Dam N, Malmberg I, Hansen BB and Lange P. Cost‐effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark – Cost‐effectiveness analysis based on five randomised controlled trials. The Clinical Respiratory Journal 2009; 3: 169–180.     

The effect of a pediatric asthma management program provided by respiratory therapists on patient outcomes and cost

OBJECTIVE: The objective was to determine whether a pediatric asthma disease management program (ADMP) provided by respiratory therapists can improve patient outcomes and reduce cost. DESIGN: This was a pre-and post-intervention observational study. METHODS: Hospitalizations, non-intensive care unit (ICU) hospital days, ICU days, emergency department visits, doctor's office visits, school days missed, and associated costs were collected on 18 children with moderate to severe asthma, ages 3 to 18 years, 12 months before and after implementation of the ADMP. The ADMP consisted of eight home visits for assessment, environmental review, and patient education. RESULTS: There were significant reductions (P < .05) in hospitalizations, hospitalization cost, ICU days, non-ICU days, length of stay, emergency department visits and cost, physician office visits and cost, and school days missed. CONCLUSIONS: A pediatric in-home ADMP provided by respiratory therapists can improve outcomes and reduce cost in patients with moderate to severe asthma.     

The economic burden of asthma: direct and indirect costs in Switzerland.

Asthma mortality increased in Switzerland between 1980 and 1994. This study aimed to assess the economic burden of asthma in this country. Chart reviews were conducted for the last five patients seen for asthma in physician practices in 1996 and 1997. Direct expenditures and indirect costs for asthma-related morbidity were determined. A total of 589 patient charts were completely analysed, including 117 children's charts, obtained from 120 office-based physicians. The annual direct medical costs were CHF 1,778 and the mean annual indirect costs were CHF 1,019 per patient for all patients. The total estimated cost of asthma in Switzerland in 1997 was nearly CHF 1,252 million. Direct medical expenditures approached CHF 762 million, or 61% of the total. In 1997, the indirect costs for asthma were estimated to have exceeded CHF 490 million. Of these costs CHF 123 million (25%) was associated with morbidity and nearly CHF 368 million (75%) was associated with looking after asthmatic patients who had to be cared for at home. This study provides evidence that asthma is a major healthcare cost factor in Switzerland, amounting to approximately CHF 1,200 million per year. The data suggest that cost savings can be achieved by improving primary care for asthma in an ambulatory setting.     

Coste económico del paciente asmático en Espa?a (estudio AsmaCost)

ObjectiveThis analysis of the cost of asthma in Spain includes both direct health care costs and indirect costs arising from illness.Patients and MethodsProspective, 12-month observational cohort study of adult patients with asthma diagnosed according to the guidelines of the Global Initiative for Asthma (GINA) and the adapted Spanish criteria (GEMA). We recorded information on health care resources utilized (medications, medical visits, emergency care, hospital admissions, and tests) and indirect costs (patient travel or transfer costs and workdays lost).ResultsA total of 627 patients throughout Spain were studied. Of these, 21.2% had intermittent asthma, 24.6% mild asthma, 27.6% moderate asthma, and 26.6% severe asthma. The total societal cost of asthma (including indirect costs) was €1726 (95% confidence interval [CI], €1314–€2154) per patient annually. Indirect costs accounted for 11.2% of the total. The cost to the National Health Service was €1533 (95% CI, €1133–€1946) per patient annually. The cost of asthma was higher for patients older than 65 years (€2079) and for those with more severe disease (€959 for intermittent asthma; €1598, mild asthma; €1553, moderate asthma; and €2635 severe asthma). Based on these findings, the total annual cost of asthma in Spain is estimated to be €1480 million (95% CI, €382–€2565 million) for patients with demonstrated bronchial hyperreactivity and €3022 million (95% CI, €2472–€3535 million) for patients diagnosed based on symptoms alone.ConclusionsThe average annual cost of asthma in adults in Spain comes to €1726 per patient, considering both direct and indirect costs. The average annual cost per patient to the National Health Service is €1533.     

Real-world treatment and health care resource use among severe asthma patients in Japan

BackgroundThere are limited studies on healthcare resource use (HCRU) among adult asthma patients in Japan using real-world evidence, and analysis on acute treatment and associated costs stratified by disease severity is further limited. This study aimed to characterize the disease burden of severe asthma patients in Japan in terms of HCRU and comorbid medical conditions, with particular interest in oral corticosteroid (OCS) dependency.MethodsThis retrospective cohort study of asthma patients used data from a claims database of diagnosis procedure combination hospitals in Japan. The severe asthma cohort included patients treated with OCS for more than 180 days in one year before the index date, with at least one asthma diagnosis claim. Comorbidity and drug use in the look-back period, HCRU, assumed OCS-related adverse events, and asthma exacerbations in the follow-up period were analyzed.ResultsCosts associated with the treatment of severe asthma were approximately twice that of mild/moderate asthma, and the annual median cost of patients hospitalized due to asthma reached ¥448,000 (USD $4073). Annual asthma exacerbation rate was higher in the severe asthma cohort than in the mild/moderate cohort. Patients with longer OCS use in the previous year had higher risks of secondary adrenal insufficiency, osteoporosis, and pneumonia in the following year.ConclusionsOCS use among asthma patients in Japan incurred greater medical and economic burden. Better understanding of the disease characteristics including the severity of asthma and appropriate management of disease burden will lead to more optimal use of healthcare resources in Japan.     

Asthma severity and medical resource utilisation.

Asthma represents a growing public health problem and the cost of asthma has been rising in many countries. The aim of this study was to estimate the direct and indirect cost of asthma among adult patients in Italy, and to assess the relationship between healthcare resource use and asthma severity according to the Global Initiative for Asthma (GINA) classification system. A multicentre cross-sectional study was conducted in 16 Italian hospital-based specialised asthma clinics. Data collection was based on self-administered questionnaires and took place during the period May 1-November 30, 1999, and 500 consecutive patients with asthma, aged 18-55 yrs, were enrolled during regularly scheduled visits. Direct costs (drugs, physician visits, emergency service use and hospitalisation), indirect costs (loss of paid workdays) and total costs were determined in euros (Euros) for 1999. Patients with more severe disease, as classified by the GINA guideline, exhibited more night-time and daytime symptoms and were more limited in performing normal daily activities. The mean total cost of asthma per patient per year was estimated to be Euros 1,260; drug costs accounted for 16%, physician costs 12%, emergency service and hospitalisation costs 20% and indirect costs 52% of the mean cost. Stratified by severity, the total annual cost per patient amounted to Euros 720, Euros 1,046, Euros 1,535 and Euros 3,328 for patients with intermittent, mild persistent, moderate persistent and severe persistent asthma, respectively. Asthma severity, as determined by the Global Initiative for Asthma classification, is significantly associated with symptoms, limitations in normal daily activities, asthma-related medical resource utilisation and both direct and indirect costs. Asthma control is not only a clinical but also an economic imperative.     

An Economic Evaluation of Asthma Action Plans for Children with Asthma

The costs and effectiveness of asthma action plans for children were evaluated in a cross-sectional economic analysis. Direct health care and indirect costs, nights with symptoms, and asthma attacks were measured in 879 Ontario children with asthma. From a societal perspective, the total annual costs of the asthma action plan and the control groups were CDN$6,948 and CDN$6,140 per patient, respectively. Health outcomes were similar. The difference in cost was attributable to greater medication and health services use in the intervention group. Prospective randomized trials are necessary to measure potential improvements in control of asthma using asthma action plans.     

Cost of severe asthma in Brazil—systematic review

Introduction: Severe asthma is characterized by frequent exacerbations, symptoms limiting daily activities and nocturnal symptoms. It requires the continuous use of medications, at high doses, and, sometimes, continuous use of oral corticosteroids, representing a significant burden to health system and society. This systematic review sought to address economic data related to severe asthma in Brazil. Method: In June 2014, electronic searches were conducted to identify relevant publications. Quality criteria were developed and applied to each selected study. In order to compare results across the selected studies, costs were refined to an annual basis, grouped according to the study perspective, inflated and converted to 2014 USD. Results: Cost analyses from the Brazilian public health system perspective were derived from two studies and showed an average annual hospital cost per patient of 135 USD and 733 USD, respectively. From the family perspective, average annual direct costs per patient varied from 764 USD to 929 USD. Conclusion: Hospitalizations and medications seem to be the most important resources funded by the Brazilian public health system and by patients and their families. Although further studies are necessary, as information on cost of this disease is scarce in Brazil, these findings suggest that there is a potential room for improving severe asthma care among Brazilian patients.     

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs.

The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches. A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches. There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n = 14) versus 187(n = 41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor's visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care. Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.     

Outcomes of a Web-based patient education program for asthmatic children and adolescents

BACKGROUND: Asthma is the most common chronic disease among children in Germany. Approaches to reduce the burden of asthma include patient education to improve self-management skills. STUDY OBJECTIVES: We determined whether a continuous Internet-based education program (IEP) as an add-on to a standardized patient management program (SPMP) improves health outcomes of asthma patients at a favorable benefit-cost ratio. PATIENTS AND METHODS: A total of 438 asthmatic patients aged 8 to 16 years in 36 study centers were enrolled during a 6-month period. We performed a prospective cost-benefit analysis alongside a nonrandomized trial. At baseline and at 6 months and 12 months, health service utilization data were collected. INTERVENTIONS: Study participants were assigned to a control group and two intervention groups. Patients in both intervention groups participated in an SPMP. Additionally, patients in one intervention group received the IEP. RESULTS: Utilization of various health-care services decreased significantly in both intervention groups. From a payer perspective, the benefit-cost ratio of the traditional education program was 0.55. Adding the IEP improved the ratio (0.79). For patients with moderate or severe asthma, the benefit-cost ratios were 1.07 and 1.42 (with IEP), respectively. CONCLUSIONS: The IEP offers the potential to decrease the burden of disease and to realize incremental morbidity cost savings. Subgroup analysis demonstrated that within 1 year, the savings exceed the intervention costs in patients with moderate or severe asthma.     

Costs of childhood asthma due to traffic-related pollution in two California communities

Recent research suggests the burden of childhood asthma that is attributable to air pollution has been underestimated in traditional risk assessments, and there are no estimates of these associated costs. We aimed to estimate the yearly childhood asthma-related costs attributable to air pollution for Riverside and Long Beach, CA, USA, including: 1) the indirect and direct costs of healthcare utilisation due to asthma exacerbations linked with traffic-related pollution (TRP); and 2) the costs of health care for asthma cases attributable to local TRP exposure. We calculated costs using estimates from peer-reviewed literature and the authors' analysis of surveys (Medical Expenditure Panel Survey, California Health Interview Survey, National Household Travel Survey, and Health Care Utilization Project). A lower-bound estimate of the asthma burden attributable to air pollution was US$18 million yearly. Asthma cases attributable to TRP exposure accounted for almost half of this cost. The cost of bronchitic episodes was a major proportion of both the annual cost of asthma cases attributable to TRP and of pollution-linked exacerbations. Traditional risk assessment methods underestimate both the burden of disease and cost of asthma associated with air pollution, and these costs are borne disproportionately by communities with higher than average TRP.     

Asthma screening, case identification and treatment in school-based programs

PURPOSE OF REVIEW: Asthma is an important health problem in school-aged children and schools seem an obvious site to find and work with under-recognized and under-treated asthma. Teachers and coaches often must deal with asthma-related symptoms or emergencies requiring knowledge, skills, and written plans and policies. In 2005, school-based asthma work focused on two areas: identification of unrecognized asthma and management of under-treated asthma. RECENT FINDINGS: Effective school-based screening requires a simple, effective screening tool. Three new asthma screening tools continue to identify more false-positive than true positive cases of asthma. Public health experts question whether asthma even fits the usual criteria for 'screening' because it does not have an asymptomatic phase. 'Case-finding' is presented as a better use of resources, allowing schools to focus on children with asthma that has been diagnosed but remains symptomatic. No school-based program based on letters, reminders, or recommendations sent to parents or community physicians changed asthma care. Three reports describe programs designed to supplement usual asthma care by providing in-school interventions, but none appeared ready for implementation in all schools in the USA. A major barrier was the continuing lack of school nurses, who must have asthma-related education and medical support to provide school-based asthma management. SUMMARY: Schools continue to be a site for asthma interventions but few of the programs, even the most intensive, influence children's asthma-related health. Most programs require modifications and further evaluation, and all require careful assessment of the burden on schools.     

Out‐of‐pocket costs for paediatric admissions in district hospitals in Kenya

Objective To describe out‐of‐pocket costs of inpatient care for children under 5 years of age in district hospitals in Kenya. Methods A total of 256 caretakers of admitted children were interviewed in 2‐week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio‐economic status was assessed through reported expenditure in the previous month. Results Seventy eight percent of caretakers were required to pay user charges to access inpatient care for children. User charges (mean, US$ 8.1; 95% CI, 6.4–9.7) were 59% of total out‐of‐pocket costs, while transport costs (mean, US$ 4.9; 95% CI, 3.9–6.0) and medicine costs (mean, US$ 0.7; 95% CI, 0.5–1.0) were 36% and 5%, respectively. The mean total out‐of‐pocket cost per paediatric admission was US$ 14.1 (95% CI, 11.9–16.2). Out‐of‐pocket expenditures on health were catastrophic for 25.4% (95% CI, 18.4–33.3) of caretakers interviewed. Out‐of‐pocket expenditures were regressive, with a greater burden being experienced by households with lower socio‐economic status. Conclusion Despite a policy of user fee exemption for children under 5 years of age in Kenya, our findings show that high unofficial user fees are still charged in district hospitals. Financing mechanisms that will offer financial risk protection to children seeking care need to be developed to remove barriers to child survival.     

Cost,Morbidity, and Control of Asthma in Hungary: The Hunair Study

Objective.?To assess asthma-related morbidity, symptom control, and societal cost of asthmatic patients in Hungary. Secondary objective was to assess the relationship between asthma symptom control and costs incurred. Methods.?Three hundred seventy-eight pediatric asthma patients (6–14 years of age) and 711 adult asthma patients (18–55 years of age) in 19 pulmonary clinics were interviewed by their physicians regarding asthma-related drug therapy and recent (past 2 weeks) asthma morbidity (daytime asthma symptoms, nocturnal symptoms, limitation in daily activities resulting from asthma and asthma exacerbation). Physicians estimated patients' level of asthma control based on the Global Initiative of Asthma guidelines. Direct and indirect costs for asthma-related resources were determined based on patient reported 6 months' data except for drug costs that were based on patient reported 2 weeks of data. All cost data were annualized. Results.?Patients in the study were mostly prescribed inhaled controller medications for asthma symptom management (76.2% pediatric and 92.3% adult) during the 2 weeks preceding the survey. Asthma-related morbidity was experienced by 15% of pediatric patients and 30% of the adult patients at least once during the 2 weeks preceding the survey. Physician classified 69% of pediatric patients as having good control, 27.5% as having moderate control, and 2.8% as having poor control of their asthma. In the adult population, 50.7% were classified as having good control, 36.6% as having moderate control, and 12.7% as having poor control. The average total annual costs (direct and indirect costs) per patient were 833 EUR (897 USD) for pediatric patients and 632 EUR (681 USD) for adult patients. In both pediatric and adult patients the total costs were highest for patients with poor asthma control. The total cost per patient increased in the ratios of 1 to 1.4 to 2.4 for pediatric patients and 1 to 1.5 to 2.9 for adult patients with good, moderate, and poor control of asthma, respectively. Conclusion.?Inhaled corticosteroids was the most frequent treatment prescribed for asthma patients in the study. However, patients reported substantial asthma-related morbidity. Children used more resources than adults, despite being classified as having better control. Patients with poor control of asthma symptoms incurred the highest societal cost, improving patient control may reduce cost to society by 40% or more.     

The cost of outpatient pneumonia in children <5 years of age in Fiji

Objectives Pneumonia is the most common reason for visiting an outpatient facility among children <5 years old in Fiji. The objective of this study is to describe for the first time the costs associated with an episode of outpatient pneumonia in Fiji, in terms of cost both to the government health sector and to the household. Methods Costs were estimated for 400 clinically diagnosed pneumonia cases from two outpatient facilities, one in the capital, Suva, and one in a peri‐urban and rural area, Nausori. Household expenses relating to transport costs, treatment costs and indirect costs were determined primarily through structured interview with the caregiver. Unit costs were collected from a variety of sources. Patient‐specific costs were summarised as average costs per facility. Results The overall average societal cost associated with an episode of outpatient pneumonia was $18.98, ranging from $14.33 in Nausori to $23.67 in Suva. Household expenses represent a significant proportion of the societal cost (29% in Nausori and 45% in Suva), with transport costs the most important household cost item. Health sector expenses were dominated by personnel costs at both sites. Both the average total household expenses and the average total health sector expenses were significantly greater in Suva than Nausori. Conclusions A single episode of outpatient pneumonia represents a significant cost both to the government health sector and to affected households. Given the high incidence of this disease in Fiji, this places a considerable burden on society.