Asthma morbidity and mortality have increased dramatically in the United States in the past 20 years. Not surprisingly, the economic impact of the disease is large, and it continues to increase. For example, the total cost of asthma was $4.5 billion in the mid-1980s compared with $6.2 to $10.7 billion in the mid-1990s.
Peter J. Gergen, M.D., M.P.H., of the Center for Primary Care Research, Agency for Healthcare Research and Quality, points out in a recent paper that economic outcomes are being reported more often in clinical trials and as part of cost-of-illness studies, but these data have limitations. For example, the level of impact of economic outcomes depends on the target audience. From a payer/provider perspective, direct costs (hospital, outpatient, and medication costs) tend to carry greater weight because these costs influence the cost of doing business. At the family/individual level, indirect costs (loss of school or work days, for example) have a much greater impact because they reflect the functioning and quality of life of the individual and family in the presence of disease.
Also, significant cost savings do not necessarily mean an improvement or deterioration in the clinical course of the disease. For example, a study looking at the impact of peak flow monitoring found reduced emergency department use among people with asthma who used the monitoring compared with nonusers, resulting in a significant cost savings. Yet other indicators of asthma activity (waking at night with asthma, beta-agonist use, self-reported asthma severity) were not different between the intervention (peak flow use) and control groups. Also, 20 percent of asthmatics in the United States use 80 percent of the resources. Thus, an intervention aimed at the whole group would not be as effective as identifying high users. Finally, cost-of-illness studies give an idea of the economic burden of asthma in a population but not for an individual or family, some of whom have used up to 30 percent of the family's gross income for asthma care.
See "Understanding the economic burden of asthma," by Dr. Gergen, in the May 2001 Journal of Allergy and Clinical Immunology 107, pp. S445-S448.
Reprints (AHRQ Publication No. 01-R076) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFAX.