Cost of asthma therapy in relation to severity. An empirical study

BACKGROUND: The aim of asthma therapy, i.e. the permanent elimination of the patient's symptoms, is as a rule, achievable over the long-term only with the aid of anti-inflammatory drugs. As well as medical, this approach also has considerable economic implications. The comparatively low compliance among asthmatics makes treatment in this context all the more difficult. An alternative that presents itself is the use of combination preparations, a mixture of a long-term prophylactic and a therapeutic agent. PATIENTS AND METHODS: With the aid of standardised questionnaires, data were acquired from 216 patients and assigned to subgroups in accordance with the degree of severity of the asthma. The patients were treated in the offices of a total of 23 GPs and internists selected at random from a complete list of all relevant practices in Germany. The use of resources, i.e. all diagnostic and therapeutic measures, was recorded retrospectively for a period of 1 year. In this way, all those resources of relevance to the health insurance carriers used during the observation period were identified. In addition to direct costs, so-called indirect costs were also estimated, i.e. in the present study the productivity loss to the economy due to illness-related absence from work. RESULTS: The annual cost of treating adult asthmatics was calculated to be DM 3,339 for level 1 severity, DM 5,260 for level 2 severity and DM 12,016 for level 3 severity. As the illness progresses in particular the direct cost of inpatient care and the indirect costs rise disproportionately. The yearly expenditure for women sufferers is about DM 800 more than for male sufferers. The direct cost of asthma treatment in children amounts to DM 2,950 for level 1, DM 3,225 for level 2, and DM 4,811 for level 3, severity. Here, drug-related costs in particular, rise significantly as the disease progresses. CONCLUSION: One of the results of the present study is the fact that for asthma sufferers in general, there is a positive correlation between average total costs and degree of severity. It may thus be postulated that preventive medical treatment of asthma that slows the progression of the illness, together with appropriate patient instruction, would have a positive effect on the total expenditure per patient. If, for example, the appropriate use of drugs in combination with patient instruction improved the compliance of asthmatics, lower treatment costs and a better quality of life for the patient could be expected.