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Uncontrolled asthma could cost US economy $963.5B over next 20 years
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The 20-year cost of uncontrolled asthma in the U.S. is estimated to exceed $963 billion, and both adolescents and adults could lose approximately 15.46 million quality-adjusted life-years as a result, according to a study published in the American Journal of Respiratory and Critical Care Medicine.
“We predicted the overall burden of uncontrolled asthma over the 2019-2038 period in the U.S. adolescent and adult population, in total and across states, if no paradigm shift occurs in the contemporary asthma management,” researchers wrote. “Of the 175.3 million patient-years with asthma in the next 20 years, 52% will be associated with uncontrolled asthma.”
Researchers from the University of British Columbia in Vancouver, Canada, developed a probabilistic model, associating state-specific estimates of population growth and aging, asthma prevalence as well as asthma control levels. They adjusted for the differences in health care resource use, QALYs and productivity loss across various levels of control.
Using this data at both the national and state-level, researchers projected the total direct and indirect costs in 2018 dollars as well as QALYs lost due to uncontrolled asthma between 2019 and 2038.
“The primary projections were made for the entire U.S. adolescent and adult population. State-level projections were provided as secondary results,” the researchers wrote. “In the main analysis, we estimated undiscounted total direct costs, indirect costs and QALYs lost attributable to uncontrolled asthma. In a sensitivity analysis we calculated outcomes after applying a 3% annual discount rate. All costs were adjusted to 2018 U.S. dollars using historical inflation rates.”
Researchers found that the total 20-year direct cost of uncontrolled asthma was approximately $300.6 billion.
“If all patients achieve asthma control during the next 20 years, $300.6 billion in direct costs can be saved. Our results therefore indicate that around 20% of direct costs of asthma can potentially be prevented by achieving asthma control in this population. When indirect costs are added, the potentially preventable burden of asthma was estimated to be $963.5 billion,” the researchers wrote.
Due to uncontrolled asthma, individuals who work 52 weeks per year could lose up to 6.6 extra weeks of productivity per year. As a result, adolescents and adults could lose an estimated 15.46 million QALYs, according to the study.
“While estimating the overall burden of a disease indeed has its own merits and should be rigorously pursued, evaluating the aspect of the burden that can realistically be prevented can more directly inform priorities in research, policy and clinical care,” the researchers wrote. “Our findings highlight the sizeable potential for cost saving and improvement in quality of life associated with better asthma control.” – by Scott Buzby
Disclosure: The study was funded by Genome Canada, Genome British Columbia and the Canadian Respiratory Research Network.
Perspective
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Kaiser Lim, MD
Q: What impact do these results have on pulmonologists and clinical practice?
A: Probably minimal since these are projected numbers that will influence policymakers but has little impact on individual practitioners. Most patients with asthma are not referred to specialty practices like allergy and pulmonary. The majority are handled by primary care providers.
Q: Do these results come as a surprise?
A: No, when Minnesota Community Measurement tracked asthma control around 10 years ago, most clinics were not measuring symptom control at all. If you don’t measure it, how will you know how patients are doing?
Q: Anything else you would like to add?
A: One should always be careful in dealing with epidemiological models and projections. While they attempt to sketch an overview, validity remains to be proven and relevance is often unclear:
- Overdiagnosis of asthma is a problem in the U.S.
- Nonadherence and medication cost are major issues in the U.S.
- There is an irrational steroid phobia in this country, especially in pediatrics.
- There is no inexpensive generic inhaled corticosteroid available in the market.
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