Asthma, Rhinitis, Other Respiratory Diseases: Rapid Publication
A comprehensive study of the direct and indirect costs of adult asthma,☆☆

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Abstract

Background: Asthma is a common and costly health condition, but most estimates of its economic effect have relied on secondary sources with limited condition-specific detail. Objective: We sought to estimate the magnitude of direct and indirect costs of adult asthma from the perspective of society. Methods: We used cross-sectional survey data from an ongoing community-based panel study of 401 adults with asthma originally derived from random samples of northern California pulmonologists, allergist-immunologists, and family practitioners to assess health care use for asthma, to assess purchase of items to assist with asthma care, and to measure work and other productivity losses. Unit costs derived from public-use and proprietary data sources were then assigned to the survey items. Results: Total per-person annual costs of asthma averaged $4912, with direct and indirect costs accounting for $3180 (65%) and $1732 (35%), respectively. The largest components within direct costs were pharmaceuticals ($1605 [50%]), hospital admissions ($463 [15%]), and non–emergency department ambulatory visits ($342 [11%]). Within indirect costs, total cessation of work accounted for $1062 (61%), and the loss of entire work days among those remaining employed accounted for another $486 (28%). Total per-person costs were $2646, $4530, and $12,813 for persons self-reporting mild, moderate, and severe asthma, respectively (P < .0001, 1-way ANOVA). Conclusion: Asthma-related costs are substantial and are driv-en largely by pharmaceuticals and work loss. (J Allergy Clin Immunol 2003;111:1212-8.)

Section snippets

Subject interviews

The data collection protocol was approved by the University of California, San Francisco, Committee on Human Research. The University of California, San Francisco Asthma Panel sampled persons with asthma recorded on visit logs maintained by a random sample of northern California adult pulmonologists, allergist-immunologists, and family practice physicians.29, 30 At the time of original enrollment, subjects ranged in age from 18 to 50 years and were interviewed at 18- to 24-month intervals

Demographics and self-rated disease severity

Table I

. General sociodemographic characteristics of interviewed adults with asthma, 1998-1999 (n = 401)

CharacteristicsFrequency
N%
Female sex28571
Race/ethnicity
Hispanic4311
Non-Hispanic white28972
Black277
Asian/pacific Islander266
Native American154
Unknown10
Education
Less than high school113
High school graduate7519
Some college14737
College graduate8020
Postgraduate8822
Marital status
Single (never married)5514
Married/long-term relationship26767
Widowed/separated/divorced5614
Unknown236
Family income
≤$20,000

Discussion

The present study of the costs of asthma, like many before it, is based on a clinical sample. Unlike those before it, however, it derives from the survey responses of persons with asthma from random samples of a wide range of physicians, and it includes a more varied array of direct and indirect costs and incorporates alternative values for the unit price for hospital admissions. We found that direct medical costs averaged $2697 per person (using the base case unit price for hospital

Acknowledgements

We acknowledge the mentorship of Dr Curtis Henke, deceased.

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    Supported by grants R01 ES10906, R01 HL56538, and R01 OH03480.

    ☆☆

    Reprint requests: Edward H. Yelin, PhD, Box 0920, University of California, San Francisco, San Francisco, CA 94143-0920.

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