Young adults with asthma have a significant financial burden of disease, with a considerable loss of income observed in patients with severe disease, according to study findings published in BMJ Open Respiratory Research.
Researchers sought to determine the cost of asthma in Denmark across disease severities compared with the general population. Data were linked on an individual basis with information from the Central Person Registry (CPR) and collected using several nationwide Danish registries.
Danish residents aged 18 to 45 years who redeemed at least 2 canisters of inhaled corticosteroid (ICS)-containing prescriptions within a 365-day period from 2014 to 2016 were defined as having actively treated asthma and were included in the analysis. These 63,130 patients with actively treated asthma were assigned to Global Initiative for Asthma (GINA) 2020 treatment steps, with step 1 (33%) and step 3 (31%) the most common.
The cost of care for the asthma group (mean age, 33 years; 55% female) was compared with care costs associated with a general population cohort 252,473 individuals from Statistics Denmark, who constituted the control group and were matched (4:1) for age, sex, civil status, and residence with the asthma group. Study participants were followed for up to 2 years after the asthma case index date unless censored by emigration date or death.
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The present study serves as an important reminder for patients, care providers, and policy-makers that asthma is a chronic disease with significant financial implications for both individual patients and on a societal level.
The overall estimated net cost per patient was €4095 (approximately $4386 in US dollars; 95% CI, €3856-€4334), which was the difference between those in the asthma vs control groups in direct health care costs, indirect costs due to loss of income, and welfare transfer payments.
The total direct health care cost for patients with asthma was €3025 (approximately $3240 in US dollars; 95% CI, €2977-€3073) annually, about twice the expenditure for individuals without asthma, for an annual increase in direct expenditure of €1555 (approximately $1665; 95% CI, €1517-€1593). Medication acquisition costs were the largest portion of direct costs (€918; 95% CI, €903-€932 annually), although only 50.6% (€465; 95% CI, €458-€433) were regarded as asthma related.
Indirect costs were calculated as income lost by individuals with asthma vs control individuals; these costs were estimated to be €1060 (approximately $1135; 95% CI, €946-€1171) annually. Societal welfare expenditure was significantly higher among those with asthma vs those without, amounting to €1485 (approximately $1591; 95% CI, €1392-€1570) per patient per year.
A U-shaped relationship was found between cost of disease and GINA steps, with step 2 having the lowest annual cost (€1902; 95% CI, €1404-€2397), compared with step 1 and steps 3 to 5.
Patients with asthma had an overall annual earned income loss of €1060 (approximately $1135; 95% CI, €946-€1171) vs those without asthma, which was offset by increases in public welfare transfers for an estimated total annual loss of net income of €310 (approximately $332; 95% CI, €88-€502). Patients who had possible severe asthma had an estimated earned income loss of €3695 (approximately $332; 95% CI, €3225-€4106), which was not fully compensated by social security and welfare transfers and resulted in an estimated total net income loss of €1387 (approximately $1485; 95% CI, €137-€2500) annually.
The total annual cost of asthma among Danish patients aged 18 to 45 was €263 million (approximately $282 million).
Study limitations included the assessment of ICS usage based on exposed dose (which seeks to approximate real-world usage) rather than based on the prescribed dose used by GINA step assessments; the use of pharmacy redemption data to determine the presence of asthma; and data limitations that prevented reliable characterization of asthma-related primary care costs.
“The present study serves as an important reminder for patients, care providers, and policy-makers that asthma is a chronic disease with significant financial implications for both individual patients and on a societal level,” stated the investigators.
Disclosure: This study was funded by an unrestricted research grant from AstraZeneca. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
