Skip to main content
SpringerLink
Log in

The Cost of Asthma

Can it be Reduced?

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient’s quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost-effectiveness analyses should be concentrated on these areas.

Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected. using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications [sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids], more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient’s home, the doctor’s office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into the most cost-effective areas of asthma care, clinical trials of asthma should include utilisation of healthcare resources as an outcome measure, and estimates of the costs of the treatment under study. In addition, since the intangible cost (quality of life) is one of the most important effects of treatment from the patient’s perspective, this should be more widely used as an outcomce measure in clinical trials.

Ultimately, prevention of asthma is the long term goal. If the hypothesis that sensitisation to house dust mite in early infancy is a major contributor to the subsequent development of asthma, then prevention may require drastic and expensive changes to current housing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Academy of Pediatrics Committee on Drugs. Precautions concerning the use of theophylline. Pediatrics 89: 781–783, 1992

    Google Scholar 

  • Arshad SH, Matthews S, Gant C, Hide DW. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet 339: 1493–1497, 1992

    Article  PubMed  CAS  Google Scholar 

  • Australian Bureau of Statistics. 1989–1990 National Health Survey, summary of results, Australia. Australian Government Printing Service, 1991

  • Barnett PJ, Oberklaid F. Acute asthma in children: evaluation of management in a hospital emergency department. Medical Journal of Australia 134: 729–733, 1991

    Google Scholar 

  • Bauman A, Hunt J, Young L, Larkin P, Peat JK. Asthma under-recognition and under-treatment in an Australian community. Australian and New Zealand Journal of Medicine 22: 36–40, 1992a

    Article  PubMed  CAS  Google Scholar 

  • Bauman A, Mitchell CA, Henry RL, Robertson CF, Abramson MJ, et al. Asthma morbidity in Australia: an epidemiological study. Medical journal of Australia 156: 827–831, 1992b

    PubMed  CAS  Google Scholar 

  • Benton G, Thomas RC, Nickerson BG, McQuitty JC, Okikawa J, et al. Experience with a metered-dose inhaler with a spacer in the pediatric emergency department. Australian Journal of Diseases in Children 143: 678–681, 1989

    CAS  Google Scholar 

  • Bolton MB, Tilley BC, Kuder J, Reeves T, Schultz LR. The cost and effectiveness of an education program for adults who have asthma. Journal of General Internal Medicine 6: 401–407, 1991

    Article  PubMed  CAS  Google Scholar 

  • Bowton DL. Editorial. Metered-dose inhalers versus hand-held nebulisers. Some answers and new questions. Chest 101: 298–299, 1992

  • Bowton DL, Goldsmith WM, Haponik EF. Substitution of metered-dose inhalers for hand-held nebulizers. Success and cost savings in a large, acute-care hospital. Chest 101: 305–308, 1992

    Article  PubMed  CAS  Google Scholar 

  • British Thoracic Society. Guidelines for management of asthma in adults. I. Chronic persistent asthma. British Medical Journal 301: 651–653, 1990a

  • British Thoracic Society. Guidelines for management of asthma in adults. II. Acute severe asthma. British Medical Journal 301: 797–800, 1990b

  • Brunett MG, Lands L, Thibodeau LP. Childhood asthma: prevention of attacks with short-term corticosteroid treatment of upper respiratory tract infection. Pediatrics 81: 624–629, 1988

    Google Scholar 

  • Bryan S, Buxton M. Economic evaluation of treatments for respiratory disease. PharmacoEconomics 2: 207–218, 1992

    Article  PubMed  CAS  Google Scholar 

  • Burke C, Power CK, Norris A, Condez A, Schmekel B, et al. Lung function and immunopathological changes after inhaled corticosteroid therapy in asthma. European Respiratory Journal 5: 73–79, 1992

    PubMed  CAS  Google Scholar 

  • Burr ML, Butland BK, King S, Vaughan-Williams E. Changes in asthma prevalence; two surveys 15 years apart. Archives of Diseases of Childhood 64: 1452–1456, 1989

    Article  CAS  Google Scholar 

  • Buxton MJ. Economic evaluation studies in respiratory medicine. Respiratory Medicine 85(Suppl. B): 43–46, 1991

    Article  PubMed  Google Scholar 

  • Campbell DA, McLennan G, Coates JR, Frith PA, Gluyas PA, et al. Accuracy of asthma statistics from death certificates in South Australia. Medical Journal of Australia 156: 860–863, 1992

    PubMed  CAS  Google Scholar 

  • Canny GJ, Reisman J, Healy R, Schwartz C, Petrou C, et al. Acute asthma: observations regarding the management of a pediatric emergency room. Pediatrics 83: 507–512, 1989

    PubMed  CAS  Google Scholar 

  • Charlton IG, Charlton IG, Broomfield J, Mullee MA. Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice. British Medical Journal 301: 1355–1359, 1990

    Article  PubMed  CAS  Google Scholar 

  • Charlton I, Jones K, Bain J. Delay in diagnosis of childhood asthma and its influence on respiratory consultation rates. Archives of Diseases of Childhood 66: 633–635, 1991

    Article  CAS  Google Scholar 

  • Christie MJ, French D, Weatherstone L, West A. The patients’ perceptions of chronic disease and its management: psychosomatics, holism and quality of life in contemporary management of childhood asthma. Psychotherapy and Psychosomatics 56: 197–203, 1991

    Article  PubMed  CAS  Google Scholar 

  • Clark NM, Feldman CH, Evans D, Levison MJ, Wasilewski Y, et al. The impact of health education on frequency and cost of health care use by low income children with asthma. Journal of Allergy and Clinical Immunology 78: 108–115, 1986

    Article  PubMed  CAS  Google Scholar 

  • Davey PJ, Leeder SR. The cost of migraine More than just a headache? PharmacoEconomics 2: 5–7, 1992

    Article  PubMed  CAS  Google Scholar 

  • Dawson KP, Jandera E, Penna AC. The prehospital management of children with acute asthma. Journal of Paediatric and Child Health 28: 321–322, 1992

    Article  CAS  Google Scholar 

  • Dawson KP, Penna AC. Observations on the management of childhood acute asthma in a large hospital. Medical Journal of Australia 156: 845–846, 1992

    PubMed  CAS  Google Scholar 

  • Djukanovic R, Wilson JW, Britten KM, Wilson SJ, Walls AF, et al. Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma. American Review of Respiratory Diseases 145: 669–674, 1992

    CAS  Google Scholar 

  • Drummond M. Cost-of-illness studies. A major headache? PharmacoEconomics 2: 1–4, 1992

    Article  PubMed  CAS  Google Scholar 

  • Drummond MF. Methods for economic appraisal of health technology. Economic appraisal of health technology in the European Community, pp. 15–48, Oxford University Press, Oxford, 1987

    Google Scholar 

  • Eigen H, Reid JJ, Dahl R, Del Bufalo C, Fasano L, et al. Evaluation of the addition of cromolyn sodium to bronchodilators maintenance therapy in the long-term management of asthma. Journal of Allergy and Clinical Immunology 80: 612–621, 1987

    Article  PubMed  CAS  Google Scholar 

  • Engel T, Heinig JH. Glucocorlicosleroid therapy in acute severe asthma - a critical review. European Respiratory Journal 4: 881–889, 1991

    PubMed  CAS  Google Scholar 

  • Evans D, Levison MJ, Feldman CH, Clark NH, Wasilewski Y, et al. The impact of passive smoking on emergency room visits of urban children with asthma. American Review of Respiratory Disease 135: 567–572, 1987

    PubMed  CAS  Google Scholar 

  • Finkler SA. The distinction between cost and charges. Annals of Internal Medicine 96: 102–109, 1982

    PubMed  CAS  Google Scholar 

  • Fleming DM, Crombie DL. Prevalence of asthma and hay fever in England and Wales. British Medical Journal 294: 279–283, 1987

    Article  PubMed  CAS  Google Scholar 

  • Freund DA, Dillus RS. Principles of pharmacoeconomic analysis of drug therapy. PharmacoEconomics 1: 20–32, 1992

    Article  PubMed  CAS  Google Scholar 

  • Geddes DM. Inhaled cortico-sleroids: benefits and risks. Thorax 47: 404–407, 1992

    Article  PubMed  CAS  Google Scholar 

  • Gergen PJ. Changing pa Herns of asthma hospitalization among children: 1979 to 1987. Journal Amedical Medical Association 264: 1688–1692, 1990

    Article  CAS  Google Scholar 

  • Gerstman BB. Prevalence and treatment of asthma in the Michigan Medicaid patient population younger than 45 years, 1980-1986. Journal of Allergy and Clinical Immunology 83: 1032–1039, 1989

    Article  PubMed  CAS  Google Scholar 

  • Gortmaker SL, Walker DK, Jacobs RH, Ruth-Ross H. Parental smoking and the risk of childhood asthma. American Journal of Public Health 72: 574–579, 1982

    Article  PubMed  CAS  Google Scholar 

  • Hall J, Mooney G. What every doctor should know about economics. Part 1. The benefits of costing. Medical Journal of Australia 152: 29–31, 1990a

    PubMed  CAS  Google Scholar 

  • Hall J, Mooney G. What every doctor should know about economics. Part 2. The benefits of economical appraisal. Medical Journal of Australia 152: 80–82, 1990b

    PubMed  CAS  Google Scholar 

  • Hargreave FE, Dolovich J, Newhouse MT. The assessment and treatment of asthma: a conference report. Journal of Allergy and Clinical Immunology 85: 1098–1111, 1990

    Article  PubMed  CAS  Google Scholar 

  • Harris JB, Weinberger MM, Nassif E, Smith G, Milavetz G, et al. Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators. Journal of Pediatrics 110: 627–633, 1987

    Article  PubMed  CAS  Google Scholar 

  • Harrison BDW, Stokes TC, Hart GJ, Vaughan DA, Ali NJ, et al. Need for intravenous hydrocortisone in addition to oral prednisolone in patients admitted to hospital with severe asthma without ventilatory failure. Lancet: 181–184, 1986

    Google Scholar 

  • Henderson J, Goldacre MJ, Fairweather JM, Marcovitch H. Conditions accounting for substantial time spent in hospital in children aged 1-14 years. Archives of Disease in Childhood 67: 83–86, 1992

    Article  PubMed  CAS  Google Scholar 

  • Higgens BG, Britton JR, Chinn S, Cooper S, Burney PGJ, et al. Comparison of bronchial reactivity and peak expiratory flow variability measurements for epidemiologic studies. American Review of Respiratory Disease 145: 588–593, 1992

    Google Scholar 

  • Higgins RM, Stradling JR, Lane DJ. Should ipratropium bromide be added to beta-agonists in treatment of acute severe asthma? Chest 94: 718–722, 1988

    Article  PubMed  CAS  Google Scholar 

  • Hoag JE, McFadden ER. Long-term effect of cromolyn sodium on nonspecific bronchial hyperresponsiveness: a review. Annals of Allergy 66: 53–63, 1991

    PubMed  CAS  Google Scholar 

  • Holt PG, McMenamin C, Nelson D. Primary sensitisation to inhalant allergens during infancy. Pediatric Allergy and Immunology 1: 3–13, 1990

    Article  Google Scholar 

  • Horn CR, Clark TJH, Cochrane GM. Can the morbidity of asthma be reduced by high dose inhaled therapy? A prospective study. Respiratory Medicine 84: 61–66, 1990

    Article  PubMed  CAS  Google Scholar 

  • Howland J, Bauchner H, Adair R. The impact of pediatric asthma education on morbidity. Chest 94: 964–969, 1988

    Article  PubMed  CAS  Google Scholar 

  • Hughes DM, McLeod M, Garner B, Goldbloom KB. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics 87: 54–61, 1991

    PubMed  CAS  Google Scholar 

  • Jenkins MA, Hurley SF, Bowes G, McNeil JJ. Use of antiasthmatic drugs in Australia. Medical Journal of Australia 153: 323–328, 1990

    PubMed  CAS  Google Scholar 

  • Jones KP, Bain DJG, Middleton M, Mullee MA. Correlates of asthma morbidity in primary care. British Medical Journal 304: 361–364, 1992

    Article  PubMed  CAS  Google Scholar 

  • Kay AB. Asthma and Inflammation. Journal of allergy and clinical immunology 87: 893–910, 1990

    Article  Google Scholar 

  • Landau LI. Smoking and childhood asthma. Medical Journal of Australia 154: 715–716, 1991

    PubMed  CAS  Google Scholar 

  • Lewis CE, Rachelefsky G, Lewis MA, de la Sola A, Kaplan M. A randomized trial of A.C.T. (Asthma Care Training) for kids. Pediatrics 74: 478–486, 1984

    PubMed  CAS  Google Scholar 

  • Littenberg B. Aminophylline treatment in severe, acute asthma. Journal of Americal Medical Association 259: 1678–1684, 1988

    Article  CAS  Google Scholar 

  • Littenberg B, Gluck EH. A controlled trial of methylprednisolone in the emergency treatment of acute asthma. New England Journal Medicine 314: 150–152, 1986

    Article  CAS  Google Scholar 

  • Marion RJ, Creer TL, Reynolds RVC. Direct and indirect costs associated with the management of childhood asthma. Annals of Allergy 54: 31–34, 1985

    PubMed  CAS  Google Scholar 

  • Marks GB, Dunn SM, Woolcock AJ. A scale for the measurement of quality of life in adults with asthma. Journal of Clinical Epidemiology 45: 461–472, 1992

    Article  PubMed  CAS  Google Scholar 

  • Martinez FD, Cline M, Burrows B. Increased incidence of asthma in children of smoking mothers. Pediatrics 89: 21–26, 1992

    PubMed  CAS  Google Scholar 

  • Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma. Annals of Internal Medicine 112: 864–871, 1990

    PubMed  CAS  Google Scholar 

  • Mellis CM. Important changes in the emergency management of acute asthma in children. Medical Journal of Australia 148: 215–217, 1988

    PubMed  CAS  Google Scholar 

  • Mellis CM, Peat JK, Woolcock AJ, Leeder SR. Morbidity and resultant costs of asthma in Australia. American Review of Respiratory Disease 145: A662, 1992

    Google Scholar 

  • Mellis CM, Peat JK, Bauman AE, Woolcock AJ. The cost of asthma in New South Wales. Medical Journal of Australia 155: 522–528, 1991

    PubMed  CAS  Google Scholar 

  • Mitchell EA. International trends in hospital admission rates for asthma. Archives or Disease in Childhood 60: 376–378, 1985

    Article  CAS  Google Scholar 

  • National Heart, Lung and Blood Institute. International consensus report on diagnosis and treatment of asthma. European Respiratory Journal 5: 601–641, 1992

    Google Scholar 

  • Northfleld M, Patel RK, Richardson A, Taylor MD, Richardson PDI. Lifestyle changes in mild asthma during intermittent symptom-related use of terbutaline inhaled via ‘Turbuhaler’. Current Medical Research and Opinion 12: 441–449, 1991

    Article  Google Scholar 

  • Parry TG. Health expenditure in Australia. The current dilemma. Medical Journal of Australia 156: 592–594, 1992

    PubMed  CAS  Google Scholar 

  • Peat JK, Haby M, Spijker J, Berry G, Woolcock AJ. Prevalence of asthma in adults in Busselton, Western Australia. British Medical Journal 305: 1326–1329, 1992

    Article  PubMed  CAS  Google Scholar 

  • Peat JK, Mellis CM. Has the prevalence of asthma increased in Australia and New Zealand? Search-Journal of the Australian and New Zealand Association for the Advancement of Science 23: 252–255, 1992

    Google Scholar 

  • Petty TL, Rollins DR, Christopher K, Good JT, Oakley R, Cromolyn sodium is effective in adult chronic asthmatics. American Review of Respiratory Disease 139: 694–701, 1989

    PubMed  CAS  Google Scholar 

  • Pierce R, Irving L. The national asthma campaign - a measurable public health exercise. Australian and New Zealand Journal of Medicine 21: 4–5, 1991

    Article  PubMed  CAS  Google Scholar 

  • Plaits-Mills TAE, Thomas WR, Aalberse RC, Vervloet D, Chapman MD, et al. Dust mite allergens and asthma: report of a second international workshop. Journal of Allergy and Clinical Immunology 89: 1046–1060, 1992

    Article  Google Scholar 

  • Ratto D, Alfaro C, Sipsey J, Glovsky M, Sharma OP. Are intravenous corticosteroids required in status asthmaticus? Journal of the American Medical Association 260: 527–529, 1988

    Article  PubMed  CAS  Google Scholar 

  • Rennick GJ, Jarman FC. Are children with asthma affected by smog? Medical Journal of Australia 156: 837–841, 1992

    PubMed  CAS  Google Scholar 

  • Ross RN. The cost of managing asthma. Journal of Respiratory Disease (Suppl.): S15–S20, 1989

    Google Scholar 

  • Ross RN, Morris M, Sakowitz SR, Berman BA. Cost-effectiveness of including cromolyn sodium in the treatment program for asthma: a retrospective, base-record study. Clinical Therapeutics 10: 188–203, 1989

    Google Scholar 

  • Sears MR, Taylor DR, Print CG, Lake DC, Li Q, et al. Regular inhaled beta-agonist treatment in bronchial asthma. Lancet 336: 1391–1396, 1990

    Article  PubMed  CAS  Google Scholar 

  • Self TH, Abou-Shala N, Burns R, Stewart CF, Ellis RF, et al. Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics. Does aminophylline add any benefit? Chest 98: 1317–1321, 1990

    Article  PubMed  CAS  Google Scholar 

  • Siegel D, Sheppard D, Gelb A, Weinberg PF. Aminophylline increases the toxicity but not the efficacy or an inhaled beta-adrenergic agonist in the treatment of acute exacerbations of asthma. American Review of Respiratory Diseases 132: 283–286, 1985

    CAS  Google Scholar 

  • Speight ANP, Lee DA, Hey EN. Underdiagnosis and undertreatment of asthma in childhood. British Medical Journal 286: 1253–1256, 1983

    Article  PubMed  CAS  Google Scholar 

  • Sporik R, Holgate ST, Platts-Mills TAE, Cogswell JJ. Exposure to house-dust mite allergen (Der pl) and the development of asthma in childhood. New England Journal of Medicine 323: 502–507, 1990

    Article  PubMed  CAS  Google Scholar 

  • Storr J. Barrell E, Barry W, Lenney W, Hatcher G. Effect of a single oral dose of prednisolone in acute childhood asthma. Lancet 1: 879–882, 1987

    Article  PubMed  CAS  Google Scholar 

  • Summer W, Elston R, Tharpe L, Nelson S, Haponik EF. Aerosol bronchodilator delivery methods. Relative impact on pulmonary function and cost of respiratory care. Archives of Internal Medicine 149: 618–623 1989

    Article  PubMed  CAS  Google Scholar 

  • Tal A, Levy N, Bearman JE. Methylprednisolone therapy for acute asthma in infants and toddlers: a controlled clinical trial. Pediatrics 86: 350–356, 1990

    PubMed  CAS  Google Scholar 

  • Tenholder MF, Bryson MJ, Whitlock WL. A model for conversion from small volume nebulizer to metered dose inhaler aerosol therapy. Chest 101: 634–637, 1992

    Article  PubMed  CAS  Google Scholar 

  • Thompson PJ, Stewart GA, House dust mile strategies in the treatment of asthma. Medical Journal of Australia 151: 408–411, 1989

    PubMed  CAS  Google Scholar 

  • Toelle BG, Peat JK, Salome CM, Mellis CM, Woolcock AJ. Towards a definition of asthma. American Review of Respiratory Disease 146: 633–637, 1992

    PubMed  CAS  Google Scholar 

  • Warner JO, Neijens HJ, Landau LI, Jones K, Asher MI, et al. Asthma: a follow up statement of an international paediatric asthma consensus group. Archives of Disease in Childhood 67: 240–248, 1992

    Article  Google Scholar 

  • Warner JO, Gotz M, Landau LI, Levison H, Milner AD, et al. Management of asthma: a consensus statement. Archives of Disease in Childhood 64: 1065–1079, 1989

    Article  PubMed  CAS  Google Scholar 

  • Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. New England Journal of Medicine 326: 862–866, 1992

    Article  PubMed  CAS  Google Scholar 

  • Weiss KB, Wagener DK. Changing patterns of asthma mortality, identifying target populations at high risk. Journal of the American Medical Association 264: 1683–1687, 1990

    Article  PubMed  CAS  Google Scholar 

  • Woolcock AJ. The problem of asthma worldwide. European Respiratory Review 1: 243–246, 1991

    Google Scholar 

  • Woolcock AJ, Peat JK, Mellis CM, Leeder SR. House dust mite atopy is important in childhood asthma but ryegrass atopy is not. American Review of Respiratory Disease 145: A662, 1992

    Google Scholar 

  • Woolcock A, Rubinfeld AR, Scale JP, Landau LI, Antic R, et al. Asthma management plan, 1989. Medical Journal of Australia 151: 650–652, 1989

    PubMed  CAS  Google Scholar 

  • Zeiger RS, Heller S, Mellon MH, Wald J, Falkoff R, et al. Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. Journal of Allergy and Clinical Immunology 87: 1160–1168, 1991

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Allen and Hanbury Epidemiology Unit, Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, 2050, Australia

    Craig M. Mellis & Jennifer K. Peat

  2. Department of Medicine, University of Sydney, Sydney, New South Wales, Australia

    Ann J. Woolcock

Authors
  1. Craig M. Mellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer K. Peat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ann J. Woolcock
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mellis, C.M., Peat, J.K. & Woolcock, A.J. The Cost of Asthma. Pharmacoeconomics 3, 205–219 (1993). https://doi.org/10.2165/00019053-199303030-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199303030-00004

Keywords

Search

Navigation