Abstract
This prospective study of 169 adult patients hospitalized for severe acute asthma in four pneumology wards compared the incidence and costs of patients who were managed (group A) or not managed (group P) before hospitalization, according to the guidelines and international recommendations (11 criteria judged by experts). Ambulatory costs were calculated by questioning patients. Valuation of hospital costs was based DRGs weighted by length of stay. The incidence in group P patients was estimated at 70%; A patients were 14 years younger than those in group P and had less severe asthma. Their annual ambulatory care prior to hospitalization was less costly irrespective of age category or degree of severity (€685 vs. €1,145 in group A); their length of hospital stay was shorter (6.03 vs. 10.78 days), resulting in a lower cost of hospitalization (€2,820 vs. €4,843). In group P a specific education program based on increased understanding, compliance, self-management, and smoking cessation, particularly in young patients should lead to reductions in hospitalizations.
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Abramson MJ, Bailey MJ, Couper FJ, Driver JS, Drummer OH, Forbes AB, McNeil JJ, Haydn Walters E (2001) Are asthma medications and management related to deaths from asthma? Am J Respir Crit Care Med 163:12–18
Adams RJ, Smith BJ, Ruffin RE (2000) Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax 55:566–573
Ad Hoc Working Group on Environmental Allergens and Asthma (1999) Environmental allergen avoidance in allergic asthma. J Allergy Clin Immunol 103:203–205
Anonymous (1987) ATS recommendations (standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma). Am Rev Respir Dis 136:225–244
Awadh B, Grunfeld A, Fitzgerald JM (1999) Health care costs associated with acute asthma: a prospective economic analysis. Can Respir J 6:521–525
Blais L, Suissa S, Boivin JF, Ernst P (1998) First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma. Thorax 53:1025–1029
Chen Y, Dales R, Krewski D (2001) Asthma and the risk of hospitalization in Canada. The role of socio-economic and demographic factors. Chest 119:708–713
Cisternas MG, Blanc PD, Yen IH, Katz PP, Earnest G, Eisner MD, Shiboski S, Yelin EH (2003) A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol 11:1212–1218
Com-Ruelle L, Dumesnil S, Lemaitre D (1997) Asthme: la place de l’hôpital. CREDES. Report no 1163
Com-Ruelle L, Crestin B, Dumesnil S (2000) L’asthme en France selon les stades de sévérité. CREDES. Report no 1290
Com-Ruelle L, Grandfils N, Midy F, Sitta R (2002) Les déterminants du cot médical de l’asthme en Ile-de-France. CREDES Série Analyse. Report no 1397
Cote J, Bowie DM, Robichaud P, Parent JG, Battisti L, Boulet LP (2001) Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation. Am J Respir Crit Care Med 163:1415–1419
Cowie RL, Underwood MF, Revitt SG, Field SK (2001) Predicting emergency department utilization in adults with asthma: a cohort study. J Asthma 38:179–184
Crane J, Pearce N, Burgess C, Woodman K, Robson B (1992) Markers of risk of readmission in the 12 months following a hospital admission for asthma. Int J Epidemiol 21:737–744
Donahue JG, Weiss JM, Livingston MA, Goetsch DK, Greineder DK, Platt R (1997) Inhaled steroids and the risk of hospitalization for asthma. JAMA 277:887–891
Eisner MD, Katz PP, Yelin EH, Shiboski SC, Blanc PD (2001) Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity. Respir Res 2:53–60
Eisner MD, Lieu TA, Chi F, Capra AM, Mondoza GR, Selby JV, Blanc PD (2001) Beta agonists, inhaled steroids, and the risk of intensive care unit admission for asthma. Eur Respir J 17:233–240
Gelber L, Seltzer L, Bouzoukis J, Pollart S, Chapman M, Platts-Mills T (1993) Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis 143:573–578
Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH (2003) Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev CD001117
Godard P, Chanez P, Siraudin L, Nicoloyannis N, Duru G (2002) Costs of asthma are correlated with severity: a 1-year prospective study. Eur Respir J 19:61–67
Johnston S, Pattemore P, Sanderson G, Smith S, Campbell M, Josephs L, Cunningham A, Robinson B, Myint S, Ward M, Tyrrell A, Holgate S (1996) The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis. Am J Respir Crit Care Med 154:654–660
Kolbe J, Vamos M, Fergusson W, Elkind G (1998) Determinants of management errors in acute severe asthma. Thorax 53:14–20
Kolbe J, Fergusson W, Vamos M, Garrett J (2000) Case-control study of severe life threatening asthma (SLTA) in adults: demographics, health care, and management of the acute attack. Thorax 55:1007–1015
Kuo A, Craig TJ (2001) A retrospective study of risk factors for repeated admissions for asthma in a rural/suburban university hospital. J Am Osteopath Assoc 101 [Suppl 5]:S4–S7
Lahdensuo A, Haahtela T, Herrala J, Kava T, Kiviranta K, Kuusisto P, Peramaki E, Poussa T, Saarelainen S, Svahn T (1996) Randomised comparison of guided self-management and traditional treatment of asthma over one year. BMJ 312:748–752
Liard L et al. (2001) Etude AIRE (Asthma Insights and Reality in Europe): Les asthmatiques en Europe. Rev Fr Allergol 41 [Suppl 1]:3–14
Marquette CH, Saulnier F, Leroy O, Wallaert B, Chopin C, Demarcq JM, Durocher A, Tonnel AB (1992) Long-term prognosis of near-fatal asthma. A 6 year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma. Am Rev Respir Dis 146:76–81
Nestor AN, Calhoun AC, Dickson M, Kalik CA (1998) Cross-sectional analysis of the relationship between national guideline recommended asthma drug therapy and emergency/hospital use within a managed care population. Ann Allergy Asthma Immunol 81:327–330
NHLBI (2002) Guidelines for the diagnosis and management of asthma: update on selected topics 2002: NAEPP expert panel report. NIH publ no 02-5075
NIH-NHLBI /WHO workshop report (2002) Global strategy for asthma management and prevention. NIH publ no 02-5075
Ordonez GA, Phelan PD, Olinsky A, Robertson CF (1998) Preventable factors in hospital admissions for asthma. Arch Dis Child 78:143–147
Partridge MR, HILL SR (2000) Enhancing care for people with asthma: the role of communication, education, training and self-management. Eur Respir J 16:333–348
Piecoro LT, Potoski M, Talbert JC, Doherty DE (2001) Asthma prevalence, cost, and adherence with expert guidelines on the utilisation of health care services and costs in a state Medicaid population. Health Serv Res 36:357–371
Salmeron S, Liard R, Elkharrat D, Muir JF, Neukirch F, Ellrodt A (2001) Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study. Lancet 358: 599–601
Sin DD, Tu JV (2001) Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics. Eur Respir J 17:380–385
Sin DD, Bell NR, Svenson LW, Man SF (2002) The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: a population-based study. Am J Med 112:120–125
Siroux V, Pin I, Oryszczyn MP, Le Moual N, Kauffmann F (2000) Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the genetics and environment of asthma. Eur Respir J 15:470–477
Sondergaard B, Thorleifsson S, Herborg H, Frokjaer B, Hepler CD, Ersboll BK (2000) Quality assurance of drug therapy for patients with asthma. Health economic analysis. Ugeskr Laeger 162:480–466
Standford R, McLaughlin T, Okamoto LJ (1999) The cost of asthma in the emergency department and hospital. Am J Respir Crit Care Med 160:211–215
Suissa S, Ernst P, Kezouh A (2002) Regular use of inhaled corticosteroids and the long term prevention of hospitalization for asthma. Thorax 57:880–884
Taytard A, Touron D (1992) Epidémiologie de l’asthme. Rev Prat 42:2395–2397
Van Ganse E, La Forest L, Pietri G, Boissel JP, Gormand F, Ben Joseph R, Ernst P (2002) Persistent asthma: disease control, resource utilisation and directs costs. Eur Respir J 20:260–267
Vidal (2002) Le dictionnaire, 78th edn. Vidal: Paris
Watson JP, Lewis RA (1996) Reducing hospitalisation in town and country asthma. Lancet 348:897
Yilmaz A, Akkaya E (2002) Evaluation of long-term efficacy of an asthma education programme in an out-patient clinic. Respir Med 96:519–524
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The present study was supported by a research grant awarded to CRESGE by the Laboratoires Internationaux de Recherche, France.
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Sailly, JC., Lenne, X., Bercez, C. et al. Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations. Eur J Health Econ 6, 94–101 (2005). https://doi.org/10.1007/s10198-005-0277-2
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DOI: https://doi.org/10.1007/s10198-005-0277-2