The Economic Burden of Asthma in Greece: A Cross-Sectional Study

  • Katerina Vellopoulou
  • Petros Bakakos
  • Stelios Loukides
  • Nikos Maniadakis
  • Georgia KourlabaEmail author
Original Research Article



The high prevalence rates of asthma worldwide and the chronic nature of the disease make asthma a major cause of morbidity, imposing a significant socio-economic burden in many countries. Specifically in Greece, the self-reported prevalence of asthma reached 9% in 2017.


The objective of this study was to estimate the total management cost of asthma in Greece and its potential determinants.


A population-based, random-digit-dialed telephone nationwide survey was conducted to recruit patients with asthma in Greece (n = 353). A structured questionnaire was used to collect data on demographic and lifestyle characteristics, exacerbations, asthma control, medical resource utilization, and productivity loss during the past 12 months. The total annual direct cost from the societal, payer, and patient perspective as well as the indirect cost was calculated. All costs refer to the year 2017 (€). The significance level was set to α = 0.05.


The mean (95% confidence interval) annual total cost per patient for asthma management from the societal, payer, and patient perspective was €895 (696–1105), €673 (497–861), and €151 (119–188), respectively. The direct medical cost accounted for almost 90% of the total cost, whereas only 4% was attributed to the indirect cost. The direct medical cost was mainly driven by the medication cost (48%). The total annual societal cost was statistically significantly higher in those with not well-controlled asthma (p = 0.014) and those experiencing exacerbations during the past 12 months (p < 0.001) than in their counterparts. The total annual economic burden of asthma in Greece was estimated at €727 million and €547 million from the societal and payer perspective, respectively.


Our findings indicate that asthma imposes a high economic burden on society and the healthcare system in Greece. Therefore, greater investment in interventions aimed at asthma control and prevention of acute exacerbations may reduce the overall burden of asthma in Greece.


Author Contributions

K.V. conducted part of the data analysis and wrote the manuscript. G.K. designed the study, conducted part of the analysis, interpreted the results, and wrote part of the manuscript. She also reviewed the manuscript. N.M., P.B., and S.L. contributed in the study design, questionnaire development, results interpretation, and manuscript writing.

Compliance with Ethical Standards


This study was funded by the Hellenic Thoracic Society. The authors would like to thank the Hellenic Thoracic Society for this sponsorship.

Conflict of Interest

The authors, Katerina Vellopoulou, Petros Bakakos, Stelios Loukides, Nikos Maniadakis, and Georgia Kourlaba declare that they have no conflicts of interest related to the content of this study.

Data Availability Statement

The dataset, along with the software code, will be provided upon request.

Supplementary material

40258_2019_469_MOESM1_ESM.docx (40 kb)
Supplementary material 1 (DOCX 40 kb)
40258_2019_469_MOESM2_ESM.docx (23 kb)
Supplementary material 2 (DOCX 23 kb)


  1. 1.
    Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2014. Accessed Jul 2017.
  2. 2.
    Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469–78. Scholar
  3. 3.
    Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1. Scholar
  4. 4.
    ERS. European Respiratory Society. European Lung White Book. 2013. Assessed Jul 2017.
  5. 5.
    Kourlaba G, Bakakos P, Loukides S, Vellopoulou K, Solakidi A, Maniadakis N. The self-reported prevalence and disease burden of asthma in Greece. J Asthma. 2018;2:1–20. Scholar
  6. 6.
    Ebmeier S, Thayabaran D, Braithwaite I, Benamara C, Weatherall M, Beasley R. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993–2012). Lancet. 2017;390(10098):935–45. Scholar
  7. 7.
    Souliotis K, Kousoulakou H, Hillas G, Bakakos P, Toumbis M, Loukides S, et al. Direct and indirect costs of asthma management in Greece: an expert panel approach. Front Public Health. 2017;5:67. Scholar
  8. 8.
    ERS. European Lung Book 2013. Available from: Accessed 24 July 2017.
  9. 9.
    Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, et al. Economic burden of asthma: a systematic review. BMC Pulm Med. 2009;19(9):24. Scholar
  10. 10.
    Antonicelli L, Bucca C, Neri M, De Benedetto F, Sabbatani P, Bonifazi F, et al. Asthma severity and medical resource utilisation. Eur Respir J. 2004;23(5):723–9.CrossRefGoogle Scholar
  11. 11.
    Godard P, Chanez P, Siraudin L, Nicoloyannis N, Duru G. Costs of asthma are correlated with severity: a 1-yr prospective study. Eur Respir J. 2002;19(1):61–7.CrossRefGoogle Scholar
  12. 12.
    Hekking PP, Wener RR, Amelink M, Zwinderman AH, Bouvy ML, Bel EH. The prevalence of severe refractory asthma. J Allergy Clin Immunol. 2015;135(4):896–902. Scholar
  13. 13.
    SEDEA. Society of Opinion and Market Research Companies (Σύλλογος Εταιρειών Δημοσκόπησης και Έρευνας Αγοράς) 2018.
  14. 14.
    Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N. The disease burden of chronic obstructive pulmonary disease in Greece. Int J Chron Obstruct Pulmon Dis. 2016;11:2179–89. Scholar
  15. 15.
    Schatz M, Mosen DM, Kosinski M, Vollmer WM, Magid DJ, O’Connor E, et al. Validity of the asthma control test completed at home. Am J Manag Care. 2007;13(12):661–7.Google Scholar
  16. 16.
    Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65. Scholar
  17. 17.
    MoH. Government Gazette issue Β' 2883. Modification of the common ministerial decision numbered .Φ.42000/οικ.2555/353/28−2−2012, (ΦΕΚ497/Β/2012), entitled: List of diseases for which the drugs are dispensed at zero or reduced copayment 2012. Available from: Accessed Apr 2017.
  18. 18.
  19. 19.
    MoH. Ministerial Decision: Diagnosis Related Groups and Daycare cost in Hellenic National Health System. 2012.Available from: Accessed April 2017.
  20. 20.
  21. 21.
    Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N. The economic burden of chronic obstructive pulmonary disease in Greece. Appl Health Econ Health Policy. 2019;17(1):111–21. Scholar
  22. 22.
    MoH. Government Gazette 2315/19-6-2018 2nd issue: Modification and replacement of the common ministerial decision with nr. Φ.90380/25916/3294/31.10.2011 (Β΄ 2011)  entitled «Unified Regulation for Health Care Benefits (EKPY) by the National  National Organization of Health Care Services Provision (ΕΟPYY)». 2018 [09.2018]. Available from:
  23. 23.
  24. 24.
    Kigozi J. The estimation and inclusion of presenteeism costs in applied economic evaluation: a systematic review. Value Health. 2017;20(3):496–506. Scholar
  25. 25.
    Hellenic Statistical Authority (ELSTAT). Permanent population per age, sex and family status, entire country and peripheries 2011. Available from: Accessed Sept 2017.
  26. 26.
    Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med. 2000;19(23):3219–36.CrossRefGoogle Scholar
  27. 27.
    Moran JL, Solomon PJ, Peisach AR, Martin J. New models for old questions: generalized linear models for cost prediction. J Eval Clin Pract. 2007;13(3):381–9. Scholar
  28. 28.
    Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;12(24):14009. Scholar
  29. 29.
    Fletcher M, Jha A, Dunlop W, Heron L, Wolfram V, Van der Molen T, et al. Patient reported burden of asthma on resource use and productivity across 11 countries in Europe. Adv Ther. 2015;32(4):370–80. Scholar
  30. 30.
    Cisternas MG, Blanc PD, Yen IH, Katz PP, Earnest G, Eisner MD, et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003;111(6):1212–8.CrossRefGoogle Scholar
  31. 31.
    Gergen PJ. Understanding the economic burden of asthma. J Allergy Clin Immunol. 2001;107(5 Suppl):S445–8.CrossRefGoogle Scholar
  32. 32.
    Bedouch P, Sadatsafavi M, Marra CA, FitzGerald JM, Lynd LD. Trends in asthma-related direct medical costs from 2002 to 2007 in British Columbia, Canada: a population based-cohort study. PLoS One. 2012;7(12):e50949. Scholar
  33. 33.
    Ismaila AS, Sayani AP, Marin M, Su Z. Clinical, economic, and humanistic burden of asthma in Canada: a systematic review. BMC Pulm Med. 2013;5(13):70. Scholar
  34. 34.
    Aumann I, Prenzler A, Welte T, Gillissen A. Epidemiology and costs of asthma in Germany—a systematic literature review [in German]. Pneumologie. 2014;68(8):557–67. Scholar
  35. 35.
    Accordini S, Corsico AG, Braggion M, Gerbase MW, Gislason D, Gulsvik A, et al. The cost of persistent asthma in Europe: an international population-based study in adults. Int Arch Allergy Immunol. 2013;160(1):93–101. Scholar
  36. 36.
    Lewis A, Torvinen S, Dekhuijzen PN, Chrystyn H, Watson AT, Blackney M, et al. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Serv Res. 2016;12(16):251. Scholar
  37. 37.
    Dal Negro RW, Micheletto C, Tosatto R, Dionisi M, Turco P, Donner CF. Costs of asthma in Italy: results of the SIRIO (Social Impact of Respiratory Integrated Outcomes) study. Respir Med. 2007;101(12):2511–9. Scholar
  38. 38.
    Schwenkglenks M, Lowy A, Anderhub H, Szucs TD. Costs of asthma in a cohort of Swiss adults: associations with exacerbation status and severity. Value Health. 2003;6(1):75–83. Scholar
  39. 39.
    Migdalis I, Rombopoulos G, Hatzikou M, Manes C, Kypraios N, Tentolouris N. The cost of managing type 2 diabetes mellitus in Greece: a retrospective analysis of 10-year patient level data “the HERCULES study”. Int J Endocrinol. 2015;2015:520759. Scholar
  40. 40.
    Maniadakis N, Kourlaba G, Cokkinos DV, Angeli A, Kyriopoulos J. The economic burden of atherothrombosis in Greece: results from the THESIS study. Eur J Health Econ. 2013;14(4):655–65. Scholar
  41. 41.
    Holbrook AL, Green MC, Krosnick JA. Telephone versus face-to-face interviewing of national probability samples with long questionnaires: comparisons of respondent satisficing and social desirability response bias. Public Opin Q. 2003;67(1):79–125. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.EVROSTON LPAthensGreece
  2. 2.1st Respiratory Medicine Department, Medical SchoolNational and Kapodistrian University of Athens, Sotiria Chest Diseases HospitalAthensGreece
  3. 3.2nd Respiratory Medicine Department, Medical SchoolNational and Kapodistrian University of Athens, Attikon General HospitalChaidariGreece
  4. 4.Department οf Health Services Organization and ManagementNational School οf Public HealthAthensGreece

Personalised recommendations