Costs of asthma are correlated with severity: a 1-yr prospective study

Abstract

Asthma prevalence is increasing and asthma-related costs are likely to increase, but few studies have analysed the relationship of asthma costs and severity. The impact of severity on costs was quantified in a cohort of 318 asthmatic patients followed up prospectively for 1 yr.Patients presenting with a broad range of severity of the disease (intermittent, mild persistent, moderate persistent, severe persistent) were recruited by chest physicians throughout France and treated for 1 yr according to customary clinical practice and following international guidelines. Severity, direct and indirect costs, and quality of life (QoL) were assessed. A multivariate analysis was conducted to relate factors contributing to the costs measured.Mean direct costs for goods and services excluding hospitalization, numbers of consultations, supplementary examinations, and the use and cost of bronchodilators and corticosteroids, indirect costs of days lost from work, and adverse QoL parameters all increased significantly with increasing severity. This also applied to mean age, body weight, asthma duration, depression of forced expiratory volume in one second, and inhaled corticosteroid posology in the 234 patients completing the study. There was a significant relationship (r=0.614, pv0.001) between direct costs (hospitalization and cures were excluded) and three domains of the QoL questionnaire (mobility, pain and energy).Overall costs of asthma (including individual direct costs, indirect costs, and intangible quality of life costs) are clearly related to severity. This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving "real-world" treatment and followed-up prospectively for 1 yr. It allowed severity to be accurately related to direct, indirect and intangible costs of asthma. Quality of life explained a significant part of these costs.

Efficacy and safety of etanercept in moderate-to-severe asthma: a randomised, controlled trial

“…The first line of therapy for asthma includes leukotriene modifiers and inhaled corticosteroids used alone or in combination with long-acting b 2 -adrenoceptor agonists (LABAs); however, ,5-15% of subjects with severe disease either do not respond or respond incompletely to this therapy [5][6][7]. For subjects with severe asthma, treatment with drugs that modify the immune response, or therapies with monoclonal antibodies directed to immunoglobulin (Ig)E or interleukin-5 are effective, although efficacy appears to be restricted to specific patient subtypes [8,9].…”

Endobronchial thermoplasty for asthma

“…The BT arm had a greater number of adverse events, 136 versus 57. Seven hospitalizations during the treatment period were required in the BT arm (4 patients) for asthma exacerbation (5) and lobar collapse (2). Medication use was compared during three phases, steroid stable phase (week 6-22), steroid wean phase (week 22-36), and reduced steroid phase (week 36-52).…”

“…Forty-five percent of asthmatics continue to have yearly exacerbations and the disease is responsible for approximately 3,600 annual deaths (1). Asthma severity and control can have major impacts on healthcare and personal expenses related to asthma (2,3).…”

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“…high doses of inhaled glucocorticosteroids in combination with long-acting b 2 -agonists (LABA) [1,2]. Management of severe asthma is associated with a high and disproportional consumption of healthcare resources [3,4]. In addition, there exists a substantial unmet clinical need.…”