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. 2019 Nov 1;200(9):1102-1112.
doi: 10.1164/rccm.201901-0016OC.

The Projected Economic and Health Burden of Uncontrolled Asthma in the United States

Mohsen Yaghoubi  1 , Amin Adibi  1 , Abdollah Safari  1 , J Mark FitzGerald  2 , Mohsen Sadatsafavi  1   2
Affiliations

The Projected Economic and Health Burden of Uncontrolled Asthma in the United States

Mohsen Yaghoubi et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Despite effective treatments, a large proportion of patients with asthma do not achieve sustained asthma control. The "preventable" burden associated with lack of proper control is likely taking a high toll at the personal and population level.Objectives: We predicted the future excess health and economic burden associated with uncontrolled asthma among American adolescents and adults for the next 20 years.Methods: We built a probabilistic model that linked state-specific estimates of population growth, aging, asthma prevalence, and asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state level, total direct and indirect (due to productivity loss) costs (in 2018 dollars) and QALYs lost because of uncontrolled asthma from 2019 to 2038.Measurements and Main Results: Total 20-year direct costs associated with uncontrolled asthma are estimated to be $300.6 billion (95% confidence interval [CI], $190.1 billion-411.1 billion). When indirect costs are added, total economic burden will be $963.5 billion (95% CI, $664.1 billion-1,262.9 billion). American adolescents and adults will lose an estimated 15.46 million (95% CI, 12.77 million-18.14 million) QALYs over this period because of uncontrolled asthma. Across states, the average 20-year per capita costs due to uncontrolled asthma ranged from $2,209 (Arkansas) to $6,132 (Connecticut).Conclusions: The burden of uncontrolled asthma is substantial and will continue to grow. Given that a substantial fraction of this burden is preventable, better adherence to evidence-informed asthma management strategies by care providers and patients has the potential to substantially reduce costs and improve quality of life.

Keywords: asthma; asthma control; costs; forecasting; quality-adjusted life years.

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Figures

Figure 1.
Figure 1.
Forest plots of adjusted odds ratio (OR) of (A) healthcare provider visits, (B) emergency department visits, (C) hospitalization, and (D) medication use associated with uncontrolled versus controlled asthma. LCL = lower confidence level; POP = population; UCL = upper confidence level.
Figure 2.
Figure 2.
Forest plots of adjusted mean difference of (A) overall productivity loss and (B) quality-adjusted life years (QALYs) lost between uncontrolled and controlled asthma. LCL = lower confidence level; MD = mean difference; OR = odds ratio; UCL = upper confidence level.
Figure 3.
Figure 3.
Trends of (A) undiscounted direct costs, (B) undiscounted indirect costs, and (C) quality-adjusted life years (QALYs) lost because of uncontrolled (vs. controlled) asthma in the United States. Squares are point estimates and lines are 95% confidence intervals.
Figure 4.
Figure 4.
Average 20-year per capita estimates of (top) direct costs, (middle) indirect costs, and (bottom) quality-adjusted life years lost associated with uncontrolled (vs. controlled) asthma for each state (in 2018 U.S. dollars).
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Comment in

  • What Will Uncontrolled Asthma Cost in the United States?
    Nurmagambetov TA, Krishnan JA. Nurmagambetov TA, et al. Am J Respir Crit Care Med. 2019 Nov 1;200(9):1077-1078. doi: 10.1164/rccm.201906-1177ED. Am J Respir Crit Care Med. 2019. PMID: 31251082 Free PMC article. No abstract available.

References

    1. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Data, statistics, and surveillance: asthma surveillance data. 2018 [updated 2018 Oct 3; accessed 2018 Aug 2]. Available from: https://www.cdc.gov/asthma/asthmadata.htm.
    1. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15:348–356. - PubMed
    1. Aalbers R, Vogelmeier C, Kuna P. Achieving asthma control with ICS/LABA: a review of strategies for asthma management and prevention. Respir Med. 2016;111:1–7. - PubMed
    1. Global Initiative for Asthma. 2018 GINA report: global strategy for asthma management and prevention. 2018 [accessed 2018 Oct 3]. Available from: www.ginasthma.org.

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