Calculating Health Care Costs Associated with Athsma in BC
To examine the economic costs of asthma in terms of the societal costs (quality of life, lost work days, etc), including the incremental cost-effectiveness of using newer, more expensive drugs that better manage asthma symptoms.
Asthma is a very common condition, and one of the few chronic diseases that is increasing in frequency. Despite the development of effective management strategies, which combine use of drugs to control symptoms and education about how to recognize and minimize environmental triggers, there is strong evidence that asthma control remains suboptimal. And while asthma related deaths and hospitalizations are declining, the human and economic costs of poorly-controlled asthma remain a significant and growing concern. As new and frequently more expensive drugs are developed, there is a need to assess both their effectiveness in reducing or controlling asthma symptoms and determine their long-term cost-effectiveness. For example, the introduction of more expensive drugs may lead to better management of asthma symptoms and reduced call on health services.
This research project involved a systematic review of previous research involving economic evaluations of asthma therapy, with a focus on findings involving the societal costs of asthma as well as the incremental cost effectiveness of using different treatments. The goal was to create a theoretical model of these costs that can be used to assess the cost effectiveness of adding different treatments. The next step will involve entering data into the model from a database containing anonymized information on all patients with asthma in BC, including the medications used and other uses of health services, to determine the incremental cost effectiveness of adding different treatments in a “real world setting.”
Findings from this research will help guide drug policy in BC to produce the most cost effective strategy for asthma in BC.
Data from the BC Linked Health Database from 1996 to 2000, including the billing information for physician visits, drug dispensations, and hospital discharge were analyzed. A unit cost was assigned to physician/ED visits, and government’s reimbursement fees for prescribed medication were obtained. All costs are reported in 2006 Canadian dollars and were adjusted for inflation rates.
We found that asthma resulted in $52.96 million in annual direct costs during the study period. The major components were medications with 67.5% of total costs, followed by hospitalization (23.2%) and physician visits (8.4%). However, if a broader definition of asthma-related hospitalization was used, hospitalizations became the major cost component. There was a statistically significant increase in cost of medications per patient towards the end of the study period (p<0.001). In 63.5% of patients, asthma was not properly controlled and this group was responsible for 94% of resource utilization.
In a significant proportion of asthma patients in BC, asthma is not properly controlled resulting in substantially higher costs. Policy makers and clinicians need to increase their awareness and adjust their practices to improve asthma management in the province. These estimates likely significantly underestimate the total cost of asthma in BC because the study focused on patients aged 5-55 and did not include older asthma patients or indirect costs such as time lost from work.