Studies Outline Asthma's Economic Toll

Although the total cost of asthma was more than $80 billion in 2013, the expansion of Medicaid in 2014 aided patients with asthma, according to 2 studies presented at the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) virtual conference.

In one study, researchers from India reviewed¹ current literature on health care resource use and cost burden of patients with asthma in the United States. They compiled papers published between 2015 and 2019 from the Embase and Medline databases that investigated the clinical and economic burden of asthma. Overall, 91 publications met inclusion criteria.

In 2013, the total cost of asthma was $81.9 billion, although this was inflated according to 2015 rates. The majority of cost resulted from absenteeism ($50.3 billion), followed by mortality ($29 billion), and losses due to missed work or school days ($3 billion). Authors note medical inflation rates between 2015 and 2020 did not drastically impact costs of overall burden in their review.

Researchers found the annual per-person incremental medical cost of asthma was $3,266 between 2008 and 2013. For school children, total annual health care expenses related to asthma were $5.92 billion in 2013, although investigators again used inflated 2015 estimates. Between 2007 and 2013, studies revealed school children and their caregivers missed 1.54 and 1.16 times the number of school or workdays to care compared with those without asthma, respectively.

In addition, a 10-year study surveying asthma-related emergency department visits between 2002 and 2012 found that 12.3% of visits resulted in hospitalization and 1% resulted in a critical care unit transfer. Another investigation of hospital readmission rates, where asthma was the primary diagnosis, within 30 days following an original asthma admission, was included in the review. From 2009 to 2013, the rate fluctuated from 5.1%, 5.4%, 5.3%, 5.1% to 5.1%, respectively.

“The identified evidence shows that despite all efforts, asthma continues to be a significant burden to children, adults, and their caregivers,” researchers wrote. “No recent costs related to burden of asthma have been identified, indicating an unmet need.”

In the second study² presented, investigators from Oregon State University estimated the impact of Medicaid expansion on prescription, health care services, and various health outcomes for individuals with asthma in 2014. Their retrospective, cross-section study included data from 12,022 adult patients with asthma between ages 18 and 64, from 2006 to 2016.

Researchers determined Medicaid coverage increased from 30% to 38% after the expansion. Medicaid beneficiaries were found to have higher prescription drug expenditures (P=.05) and lower utilization (P=.84) compared with their counterparts following the expansion.

Out-of-pocket expenditure also decreased by roughly $11 per individual for preventive drugs like leukotriene modifiers. However, authors found the probability of taking daily preventative drugs increased by 12.4% .

The probability of asthma attacks, use of inhalers, and emergency room (ER) visits also increased.

“Medicaid expansion was beneficial to asthma patients,” authors concluded. “But additional studies need to be conducted to identify the reason for increasing asthma-related ER visits when preventive drug utilization also increased.”

References:

1. Kaushik P, Kumar S, Sharma C, et al. Healthcare cost and resource use burden of asthma in the United States- A systematic literature review. Presented at: ISPOR 2020; May 18-20; Abstract PRS12.
2. Shi L, Luck J. Does Medicaid expansion provide affordability of healthcare and better health outcome for asthma population. Presented at: ISPOR 2020; May 18-20; Abstract PRS48.