Is There a Solution to the Rising Costs of Asthma?

Asthma has high associated costs – direct, indirect and supplementary. Direct costs include hospitalizations, visits to Emergency Rooms, visits to offices of health care providers, medications, and related expenses, while indirect costs include missed school and work days, reduced productivity, loss of advancement, disease-related discrimination, disruption to family life, the continuing need for environmental control, and a significantly reduced quality of life.1-8 Obvious supplementary costs – such as those incurred to change bedrooms and homes to make them more asthma-friendly – are rarely considered when estimating the total cost of asthma in the USA.

But there are even more costs that should be considered. These include quantifiable items such as transportation costs and time spent on medical appointments, as well as the cost of pain and suffering which cannot be quantified. Then there are patients who, because of their asthma:

  • are unable to function at school or work
  • are forced to choose a line of work because of disease-imposed limitations
  • suffer limited career advancement
  • die, thus depriving society of all their contributions.

Societal costs of asthma in the USA have been calculated since the 1990s, and the costs associated with the measurable items related to asthma increased till 2012. Table 1 shows those costs in billions of US dollars.

2018-Asthma Costs.png

The cost estimates in the study, 9 which was published in the Annals of the American Thoracic Society, are believed to be low since they assumed a prevalence of asthma of about 5%. This may be a considerable underestimation since the data available was based only on individuals who were receiving treatment through actual visits to providers, pharmacists, emergency rooms or hospitals. It did not include people with asthma who did not use some form of healthcare service in a particular year. Further, the National Health Interview Survey put the number of those who currently have asthma at 8%. 10

The study9 did find that the cost of prescription asthma drugs and office visits comprised the bulk of the medical costs. Based on a per-capita basis, the incremental annual cost per patient in 2015 USD was

  • $1,830 for prescription medications
  • $640 for office visits
  • $529 for hospitalizations
  • $176 for hospital outpatient visits
  • $105 for emergency room visits

Blacks and Hispanics had lower medical costs when compared with the average population, and this was attributed to their

  • higher hospitalization and emergency room visits for asthma
  • lower outpatient visits
  • lower use of prescription medication

Among the other findings in the study were the following:

  • women and blacks were more likely to have asthma
  • married adults were less likely to have asthma
  • a large proportion of people with asthma lived at or below the poverty line, and had significantly higher medical costs from asthma than those with higher incomes
  • compared with individuals without asthma, children and adults with asthma missed more school and work days

A disappointing statistic was that the deaths from asthma between 2008 and 2013 continued to rise.

The Solution

A study by Suh and colleagues11 showed that a targeted asthma intervention program which increased patients’ asthma medication costs by $1 (one dollar) could reduce per-patient costs by

  • $149 for hospitalization
  • $16 for emergency room visits
  • $82 for physician visits.

Bunting and Cranor12 found that asthma education could save per patient annually on average

  • direct cost savings of $725
  • indirect cost savings of $1,239
  • a decrease in missed work days from 10.8 days to 2.6 days/year

Yet another study13 found that the use of an asthma educator made a difference. Over the study period the costs per patient were

  • $12,188      for the control group healthcare costs
  • $6,000      for the intervention group healthcare costs
  • $186            per patient cost of intervention
  • $6,462        per patient savings in direct and indirect costs

Other interventions14 that involve educating children about their asthma have also shown a substantial decline in costs. Savings ranged from $4,021 to $4,503 per child per year as well as a reduction of

  • 81% for hospitalizations
  • 69% for hospital days
  • 64% for emergency room visits
  • 58% for clinic visits

A number of other studies15-19 have also shown how effective patient education is in reducing direct and indirect costs. It is to be hoped that the increasing emphasis on asthma education that has occurred in the last few years will continue to make a difference not only to costs, morbidity and mortality but also to the quality of life of asthma patients. Asthma education reduces costs and enhances health.

References

  1. Nunes C, Pereira AM, Morais-Almeida M.  Asthma costs and social impact. Asthma Res Pract. 2017 Jan 6;3:1. doi: 10.1186/s40733-016-0029-3. eCollection 2017.
  2. Centers for Disease Control and Prevention. Asthma Facts—CDC's National Asthma Control Program Grantees,  Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2013.  https://www.cdc.gov/asthma/pdfs/ asthma_facts _program_grantees.pdf
  3. Sullivan PW, Ghushchyan VH et al. The burden of adult asthma in the United States: evidence from the Medical Expenditure Panel Survey. J Allergy Clin Immunol. 2011 Feb;127(2):363-369.e1-3. doi: 10.1016/j.jaci.2010.10.042.
  4. Miller GF, Coffield E, Leroy Z, Wallin R. Prevalence and costs of five chronic conditions in children. J Sch Nurs. 2016 Oct;32(5):357-64. doi: 10.1177/1059840516641190.
  5. Sullivan PW, Ghushchyan VH, et al. Measuring the cost of poor asthma control and exacerbations. J Asthma. 2017 Jan 2;54(1):24-31. doi: 10.1080/02770903.2016.1194430.
  6. Nurmagambetov T, Khavjou O, Murphy L, Orenstein D. State-level medical and absenteeism cost of asthma in the United States. J Asthma. 2017 May;54(4):357-370. doi: 10.1080/02770903.2016. 1218013.
  7. Zeiger RS, Schatz M, et al. Utilization and costs of severe uncontrolled asthma in a managed-care setting. J Allergy Clin Immunol Pract. 2016 Jan-Feb;4(1):120-9.e3. doi: 10.1016/j.jaip.2015.08.003
  8. Wang LY, Zhong Y and Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Dis. 2005 Jan; 2(1): A11. PMC1323314
  9. Nurmagambetov T, Kuwahara R and Garbe P. The economic burden of asthma in the United States, 2008-2013. Ann Am Thorac Soc 2018; DOI: 10.1513/AnnalsATS.201703-259OC.
  10. https://www.cdc.gov/nchs/fastats/asthma.htm.
  11. Suh DC, Shin SK et al. Impact of a targeted asthma intervention program on treatment costs in patients with asthma. Am J Manag Care 2001; (9): 897-906. http://www.ajmc.com/journals/issue/2001/2001-09- vol7-n9/Sep01- 304p897-906/
  12. Bunting BA and Cranor CW. The Asheville Project: Long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc 2006; 46(20):133-147
  13. Castro M, Zimmermann NA, et al. Asthma intervention program prevents readmissions in high healthcare users. Am J Respir Crit Care Med. 2003 Nov 1;168(9):1095-9.
  14. Karnick P, Margellos-Anast H, et al. The pediatric asthma intervention: a comprehensive cost-effective approach to asthma management in a disadvantaged inner-city community. J Asthma. 2007 Jan-Feb;44(1):39- 44.
  15. Turyk M, Banda E et a. A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity. J Asthma. 2013 Sep;50(7):729-36. doi: 10.3109/02770903.2013.796971.
  16. Franco R, Santos AC, do Nascimento HF, et al. Cost-effectiveness analysis of a state funded programme for control of severe asthma. BMC Public Health. 2007 May 17;7:82
  17. Halpin HA, McMenamin SB, Pourat N, Yelin E. An analysis of California Assembly Bill 2185: mandating coverage of pediatric asthma self-management training and education. Health Serv Res. 2006 Jun; 41 (3Pt 2): 1061-80
  18. Yong YV, Shafie AA. Economic evaluation of enhanced asthma management: a systematic review. Pharm Pract (Granada). 2014 Oct;12(4):493. Epub 2014 Mar 15.
  19. Nkoy F, Fassl B, et al. Improving pediatric asthma care and outcomes across multiple hospitals. Pediatrics. 2015 Dec;136(6):e1602-10. doi: 10.1542/peds.2015-0285.