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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Cisternas MG et al; "A Comprehensive Study of the Direct and Indirect Costs of Adult Asthma." Journal of Allergy and Clinical Immunology; V.111; No.6; 6/03; p1212
      STUDY DESIGN: This study estimated the costs of asthma from the perspective of society. The study derives from northern California adults with asthma obtaining care from random samples of pulmonologists, allergist-immunologists, and family practitioners over a prospective period of enrollment. Thus, although this is a clinical cohort, it is based on systematic samples of community and not tertiary-care practitioners. At the time of original enrollment, subjects ranged in age from 18 to 50 years and were interviewed at 18- to 24-month intervals thereafter. The 401 follow-up interviews on which this article is based occurred between 1998 and 1999. All costs tabulated for this study are specifically associated with asthma.
      MEDICATION AND OUTPATIENT UTILIZATION: Virtually all of the panel subjects reported taking at least one asthma-related medication (98%); three-fourths of the subjects reported ambulatory asthma visits other than to emergency departments, and the same percentage reported at least one outpatient procedure for asthma in the previous year.
      TOTAL COSTS: Mean total asthma-related costs were $4912 per patient and were reported as $2646, $4530, and $12,813 for patients with self-reported mild, moderate, and severe asthma, respectively.
      DIRECT COSTS: Medical costs accounted for 85% of the direct costs, with prescription medications, at $1605, accounting for half of the total direct costs. In the sensitivity analysis, using 75% of the average wholesale price as the unit price for drugs, medications, at $1271, accounted for 45% of total direct costs. Other large components of direct costs included hospital admissions ($463, or 15% of the total) and ambulatory care excluding the use of emergency departments (11%). Emergency department use (6%) and outpatient procedures (3%) accounted for relatively little of the total cost. Of the $342 per person associated with non-emergency department ambulatory care, visits to physicians were responsible for all but $32. Of the $1605 total per person accounted for by medications, prescription asthma bronchodilators and anti-inflammatory drugs were responsible for $962, whereas other asthma prescriptions and nonprescription drugs (including herbal remedies) accounted for $581 and $61, respectively.
      Mean direct medical costs, driven in large part by medication and ambulatory care, increased from $1681 for the half reporting mild asthma to $2473 among the third reporting moderate disease and to $6354 for the 16% with severe disease. Mean medication costs were reported as $1252, $1746, and $2404; mean hospitalization costs were reported as $102, $215, and $2122; and direct nonmedical costs increased from $382 to $570 to $613 for the groups with mild, moderate, and severe disease, respectively.
      INDIRECT COSTS: Indirect costs associated with asthma averaged $1732 per person, even though fewer than one-fifth experienced any such costs. Mean indirect costs were reported as $582, $1488, and $5846 among patients with mild, moderate, and severe asthma, respectively. 61% ($1062) of the indirect costs were due to the total cessation of work activities attributed to asthma, although only 5% of the respondents had stopped working altogether for this reason. Another 28% and 6% of the indirect costs, respectively, were due to the loss of full and partial work days among those who remained employed.
      DISCUSSION: Medications accounted for the largest share of direct costs (50%), principally because of the high unit cost and widespread use of prescription bronchodilators and anti-inflammatory drugs. After medications, hospital admissions were the next largest component, about 15% of the direct cost total. Medication costs were incurred by 98% of respondents. In contrast, the 15% of the direct cost total associated with hospital admissions were incurred by only a small proportion of the persons with asthma (approximately 7%). Thus the high medication costs are due to the combination of frequent use and high unit prices, whereas the high cost of hospital admissions is principally the result of high unit prices.
      Approximately 3.5 million American adults aged 35 to 64 years have symptomatic asthma. If the results of the present study concerning the distribution of self-reported severity levels among adults and their costs were applied to such national prevalence data, the savings that might accrue from a 5% shift in the proportion from severe to moderate asthma would be in the range of $1.4 billion dollars annually.

Search Criteria: Text - Journal of Allergy and Clinical Immunology; V.111; No.6; 6/03; p1212