Background
Methods
Literature Search
Study Selection
Inclusion Criteria | Exclusion Criteria |
---|---|
• English language | • Conference abstracts, case reports, letters, comments, editorials and review papers |
• Studies that consider the costs of asthma from either the individuals', the health services', and/or society's perspective | • Studies that consider asthma with other comorbidities (such as allergies, COPD, etc) |
• Pharmacodynamic or pharmacokinetic studies | |
• Studies that did not quote costs in the results section | |
• Animal or in vitro studies |
Data Abstraction
Methodological Quality Assessment
1. Was a well-defined question asked in an answerable form? |
2. Was a comprehensive description of the competing alternatives provided? |
3. Was there evidence that the program's effectiveness was established? |
4. Were all the important and relevant costs & consequences identified? |
5. Were costs and consequences measured accurately with appropriate physical units? |
6. Were costs and consequences credibly valued? |
7. Were costs and consequences adjusted for differential timing? |
8. Was an incremental analysis of costs and consequences of alternatives performed? |
9. Was a sensitivity analysis performed? |
10. Did the presentation and discussion of the study results include all issues of concern to users? |
Statistical Analysis
Results
Literature Search
Quality Assessment
Characteristics of the Selected Studies
Direct Versus Indirect Costs of Asthma
References No. | Country | Study duration | Sample size | Total direct cost/person | Mean annual direct cost/person | % | Total indirect cost | Total cost | Mean annual cost/person |
---|---|---|---|---|---|---|---|---|---|
Institutional studies | |||||||||
11
| US | 1 yr | 401 | - | 3,307 | 65 | 1,801 | - | 4,158 |
18
| Canada | 1 yr | 149 | 196,898ϕ | - | 74 | 67,729 | 264,627 | - |
- | - | - | - | - | |||||
42
| Canada | 1 yr | 339 | - | 1,200 x | 88 | 157 | - | 1,357 |
752 y | 100 | - | 752 | ||||||
85 z | 56 | 66 | 151 | ||||||
Regional studies
| |||||||||
47
| Australia | 1 yr | 1.2 m | 273 | - | 77 | 81 | 354 | - |
National studies
| |||||||||
14
| US | 1 yr | 4.7 m | 7,301 | - | 88 | 955 | 8,256 | - |
29
| Canada | 1 yr | N/A * | 397 | - | 61 | 257 | 654 | - |
48
| Switzerland | 1 yr | N/A * | 860 | - | 61 | 553 | 1,413 | - |
49
| US | 1 yr | N/A * | 3,822 | - | 53 | 3,367 | 7,189 | - |
58
| US | 10 yrs | 14.2 m | 8,665 | - | 57 | 6,583 | 15,248 | - |
References No. | Country | Study duration | Sample size | Total indirect cost | Mean annual indirect cost/person | % | Total direct cost | Total cost | Mean annual cost per person |
---|---|---|---|---|---|---|---|---|---|
Institutional studies | |||||||||
13
| Spain | 1 yr | 333 | - | 2,749 | 69 | 1,221 | - | 3,970 |
17
| Italy | 1 yr | 500 | - | 1,068 | 52 | 970 | - | 2,038 |
22*
| US | 1 yr | 638 | - | n/a | 55 | 488 | - | 727 |
50
| Denmark | 1 yr | 115 | 822,067 | - | 67 | 402,668 | 1,224,735 | - |
National studies
| |||||||||
51
| Germany | 1 yr | 52,794 | n/a | - | 75 | - | 4.43 b | - |
Direct Cost of Asthma
Hospital Admission
References No. | Country | Study duration | Sample size | Cost of inpatient care/person | Total direct cost | Total asthma related cost/person | Total asthma related cost | |||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | 95%CI | % | |||||||
Institutional studies | ||||||||||
15
| Canada | 1 yr | 940 | 614¥
| - | - | - | 1,421 | - | - |
28
| Australia | 1 yr | 245 | 397 | - | - | - | - | 779 | - |
30
| France | 1 yr | 17 ** | 229 | 282.4 | - | 52 | - | - | 6,856 |
38
| UK | 1 yr | 29* | 439 | 816 | 0–2,895 | 57 | - | - | 773 |
42
| Canada | 1 yr | 339 | 591 | - | - | 77ψ
| - | 766 | - |
48
| Switzerland | 1 yr | 589 | 928 | - | - | 47ξ
| 1,779 | - | - |
52
| Spain | 3 mo | 126 | 1,932 | - | 1,529–2,353 | 83 | 2,338 | - | - |
53
| France | 1 yr | 94** | 64,675ϕ | - | - | 86 | - | - | 745,847 |
Regional studies
| ||||||||||
54
| US | 1 yr | 530,000 | 7.8 m | - | - | - | - | - | 20 m |
National studies
| ||||||||||
14
| US | 1 yr | 4.7 m | 4 b | - | 2 – 6 b | 54 | 7 b | - | - |
20
| Singapore | 1 yr | 27,164** | 12 m | - | - | - | 25 m | 346 | 49 m |
49
| US | 5 yrs | 463,500** | 1.6 b | - | - | 67 | 4 b | - | 7.2 b |
Asthma Cost and Hospital Characteristics
Asthma Medications
References No. | Country | Study duration | Sample size | Cost of medication/person | Total direct cost | Total cost | Mean annual cost/person | |||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | 95%CI | % | |||||||
Institutional studies | ||||||||||
11
| US | 1 yr | 401 | 2,070 | 50 | 4,101 | ||||
13
| Spain | 1 yr | 333 | 552 | 454 | 45 | 1,221 | 3,971 | ||
15
| Canada | 1 yr | 940 | 56¥ | 82 | |||||
16
| Italy | 1 yr | 446 | 240 | 181–299 | 47 ν | 1,186 | |||
19
| Turkey | 1 yr | 118 | 1,388 | 109 | 81 | 1,713 | |||
22
| US | 1 yr | 638 | 141 | 53 ψ | 488 | 727 | |||
23
| France | 1 yr | 234 | - | 60–75 ξ | - | ||||
27
| Sweden | 1 yr | 220 | 463 | 56 | 822 | 0.62 b | 2,655 | ||
28
| Australia | 1 yr | 245 | 55 | 89¢
| 235 ¥ | ||||
35
| Switzerland | 1 yr | 263 | 814 | 735 | 70 | 1,156 | |||
55
| Thailand | 1 yr | 183 | 72 | 111 | 47 | 154 § | |||
60
| Estonia | 1 yr | 1,423 | 154,140ϕ | 53 ψ | 3.60 m | 203 | |||
Regional studies
| ||||||||||
37
| US | 1 yr | 25,614 | - | 38 | 679 | ||||
47
| Australia | 1 yr | 1.2 m | 147 m | 54 | 273 m | 354 m | |||
National studies
| ||||||||||
29
| Canada | 1 yr | N/A* | 164 m | - | 404 m | ||||
43
| US | 1 yr | 2.52 m | 495 m | 66 | 43 | 2.3 b | |||
51
| Germany | 1 yr | 52,794 | 0.58 b | 84 | 0.69 b | 2.74 b |
Physician Visits/Outpatient Clinic
Cost of Asthma and Category of Service
Insurance Coverage
Indirect Cost of Asthma
References No. | Country | Study duration | Sample size | Productivity loss/person | Total indirect cost | Total asthma related cost | |||
---|---|---|---|---|---|---|---|---|---|
Mean | SD | 95%CI | % | ||||||
Institutional studies | |||||||||
10
| US | 1 yr | 3528 | 83 | - | - | - | 148 | - |
11
| US | 1 yr | 401 | 1,370 | - | - | 61 | 2,234 | - |
13
| Spain | 1 yr | 333 | 553,569 ϕ | - | - | - | 915,674 | - |
15¥
| Canada | 1 yr | 940 | 935 | - | - | 92 | 1,018 | - |
1,411 | - | - | 50 | 2,836 | - | ||||
16
| Italy | 1 yr | 527 | 416 | - | 261–573 | 53 | 663 | - |
18
| Canada | 1 yr | 149 | 44,623 | - | - | - | 67,729 | - |
21
| US | 1 yr | 443 | 1,437 | 3732 | - | - | 1,788 | - |
23* | France | 1 yr | 318 | - | - | - | - | - | |
26
| Hungary | 1 yr | 378 x | 540 | - | - | - | 1,132 | - |
711 y | 170 | - | - | - | 810 | - | |||
27
| Sweden | 1 yr | 115 | 1,399 | - | - | 76 | 1,778 | - |
42
| Canada | 1 yr | 339 | 66 | - | - | 44 | 150 | - |
50
| Denmark | 1 yr | 115 | 760,853 ϕ | - | - | 62 | 822,067 | 1.2 m |
National studies
| |||||||||
14
| US | 1 yr | 35000 | 315 m | - | 113–517 | 33 | 955 m | 8,256 m |
20
| Singapore | 1 yr | 142,300 | 18.5 m | - | - | 37 | 24.31 m | 49.36 m |
43
| US | 1 yr | 2.52 b | 821 m | - | - | - | 1,124 m | 2.3 b |
48
| Switzerland | 1 yr | N/A | 414 m | - | - | 75 | 551 m | 1,413 m |
49
| US | 1 yr | N/A | 1,448 m | - | - | - | 4.2 b | 7.2 b |
58
| US | 10 yrs | 14.2 m | 1,902 m | - | - | - | 6,583 m | 15,248 m |
Cost of Asthma and the Associated Risk Factors
Severity
Severity | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Intermittent | Mild | Moderate | Severe | Subgroups | ||||||||||||
References No. | Country | Study duration | Total n | n | Cost | n | Cost | n | Cost | n | cost | |||||
Institutional | ||||||||||||||||
11
| US | 1 yr | 401 | - | - | 200 | 3339 | 137 | 5,716 | 64 | 16,168 | |||||
13
| Spain | 1 yr | 333 | - | - | 140 | 257,979 | 116 | 385,239 | 77 | 679,091 | |||||
15
| Canada | 1 yr | 940 | - | - | 1,799 | 2,466 | 4,344 | Societal perspective | |||||||
- | 256 | 744 | 459 | 862 | 225 | 1,192 | Ministry perspective | |||||||||
- | 877 | 1,079 | 1,763 | patient perspective | ||||||||||||
19
| Turkey | 1 yr | 118 | 4 | 202 | 54 | 1,006 | 46 | 1,954 | 14 | 4,081 | |||||
21
| US | 1 yr | 3002 | - | - | 787 | 5,390 | 1194 | 6,838 | 988 | 9,020 | |||||
23
| France | 1 yr | 318 | 32 | 435 | 78 | 1,134 | 91 | 1,977 | 33 | 4,598 | |||||
27
| Sweden | 1 yr | 115 | 53 | 359 | 62 | 4,473 | |||||||||
30
| France | 1 yr | 261 | - | - | 108 | 606 | 58 | 704 | 63 | 561 | Good control | ||||
- | 1,184 | 808 | 1,426 | Moderate control | ||||||||||||
- | 329 | 741 | 4,476 | Poor control | ||||||||||||
35
| Switzerland | 1 yr | 422 | 14 | 511 | 31 | 1,440 | 42 | 3,487 | 72 | 5,228 | |||||
36
| US | 1 yr | 3223 | 515 | 2,875 | 431 | 3,973 | 101 | 6,303 | 27 | 19,820 | |||||
46
| Thailand | 1 yr | 511 | - | 104 | - | 125 | - | 182 | - | 224 | |||||
52
| Spain | 3 mo | 126 | - | - | - | 515 | - | 1,926 | - | 5,544 | |||||
53
| US | 1 yr | 1038 | - | - | - | 536 | - | 1,255 | - | 627 | Good control | ||||
- | 354 | 651 | 200 | 1,119 | 347 | 1.214 | Moderate control | |||||||||
- | 1,903 | 1,953 | 1,808 | Poor control | ||||||||||||
57
| France | 1 yr | 169 | 66 | 3,942 | 53 | 4,608 | Group P | ||||||||
23 | 4,527 | 27 | 9,574 | Group A | ||||||||||||
62
| Turkey | 1 yr | 183 | - | - | 124 | 806 | 36+23 | 1,729 | |||||||
67
| US | 2 yrs | 2213 | - | - | 1,007 | 463 | 237 | 374 | 969 | 2,362 | |||||
41
| Australia | 1 yr | 193 | No visits | One visit/yr | 2 Visits/yr | >2 Visits/yr | Urgent visit | Hospitalization | |||||||
n | $ | n | $ | n | $ | n | $ | n | $ | n | $ | |||||
35 | 80 | 26 | 195 | 38 | 207 | 55 | 202 | 31 | 298 | 8 | 819 | |||||
Regional
| ||||||||||||||||
50
| Denmark | 1 yr | 115 | 16 | 755 | 47 | 8,856 | 48 | 13,201 | 4 | 40,677 | |||||
17
| Italy | 1 yr | 500 | 174 | 1,165 | 134 | 1,692 | 153 | 2,507 | 39 | 5,382 | |||||
National
| ||||||||||||||||
66
| 11 countries | 1 yr | 1201 | - | 1,143 | - | 1,113 | - | 1,213 | - | 1,480 | |||||
10 countries | 1124 |
Poor Asthma Management
Reference No. | Country | Study duration | n | Asthma control | Cost stratified by severity | |||
---|---|---|---|---|---|---|---|---|
Low | Moderate | High | ||||||
50
| Denmark | 1 yr | 39 | Well treated | 8,948 | |||
76 | Poorly treated | 11,523 | ||||||
53
| US | 1 yr | 515 | Well treated | 536 | 651 | 1,903 | |
294 | Intermediate | 1,255 | 1,117 | 1,954 | ||||
128 | Poorly treated | 627 | 1,214 | 1,808 | ||||
14
| Italy | 1 yr | Well treated | 593 | ||||
527 | Poorly treated | 2,099 | ||||||
20
| Hungary | 1 yr | 248 | Pediatrics | Well treated | 973 | ||
98 | Intermediate | 1,374 | ||||||
10 | Poorly treated | 2,651 | ||||||
352 | Adults | Well treated | 554 | |||||
254 | Intermediate | 861 | ||||||
88 | Poorly treated | 1,632 |