Asthma Research Unit - Research Poster

Asthma Research Unit Posters

Counting the Costs of Poorly
Controlled Asthma in the Community

Presented at the
American Thoracic Society Conference
April 1999, in San Diego

G Hoskins, C McCowan, R G Neville,
B Smith, G E Thomas, S Silverman

Aim

To assess the impact of poorly controlled asthma on overall healthcare by comparing resource use of those who suffer ‘attacks’ with those who do not.

Method

Two identical studies involved the audit of asthma management within a general practice setting. 393 practices from throughout the United Kingdom provided details of health service resource use over a retrospective 12 month period for 30 (minimum) patients randomly selected from the practice active asthma register. This provided a data set on the management of 12,203 patients (50% male) with asthma. All patients were invited for a clinical assessment. The database was utilised to determine whether usage of health service resource related to asthma control. Published unit cost data was then used to construct cost estimates for different management options. By pricing each individual item of resource use as in table 2, patient costs were calculated. The mean management costs, including confidence intervals, of patients who had experienced an asthma attack were compared with those who had not.

Results

Resource use for those who did & did not have an attack
Table 1	Attack n=2653	No Attack n=9550
Number of: Patient initiated GP consultations	7096	8731
Patient initiated nurse consultations	816	1472
Practice GP reviews	2922	3818
Practice Nurse reviews	3818	10 219
Number of patients given:
Systemic steroids	1675(63%)	526(6%)
Emergency bronchodilators	824(31%)	71(1%)
Prophylactic Medication	2321(87%)	6716(70%)
Number of patients who attended:
Accident & Emergency (ER)	327(12%)	39(0.5%)
Hospital Admission	331(12%)	51(0.5%)
Outpatients	392(15%)	349(4%)

Breakdown of healthcare costs comparing the attack group with those who did not have an attack
Table 2		Costs per patient (�)
Cost	Total cost (�)	Had an Attack (n=2653)	95% confidence interval	Had no attack (n=9550)	95% confidence interval
Patient initiated GP consultations	142 443	24.07	23.24 to 24.90	8.23	7.96 to 8.50
Practice initiated GP consultations	94 360	15.42	14.40 to 16.44	5.60	5.32 to 5.88
Patient initiated nurse consultations	13 728	1.85	1.66 to 2.03	0.92	0.85 to 1.00
Nurse review	84 222	8.63	8.21 to 9.06	6.42	6.24 to 6.60
Systemic steroids	3550.50	1.01	0.96 to 1.07	0.09	0.07 to 0.11
Emergency bronchodilators	386.75	0.13	0.12 to 0.15	0.003	0.002 to 0.004
Drugs	1 050 656.85	127.38	121.42 to 133.33	74.63	72.34 to 76.92
A&E (ER) visits	28 470.80	9.73	8.28 to 11.18	0.28	0.18 to 0.38
Hospital stay	516 054.64	169.18	139.89 to 198.46	7.04	4.13 to 9.95
Outpatients	107 549.66	23.69	20.45 to 26.93	4.68	4.10 to 5.26
Total	2 041 422.20	381.09	348.07 to 414.11	107.89	103.87 to 111.92

Conclusion

The average annual cost of treating patients who are not controlled is �381.09 ($637 using a conversion rate of �1 = $1.672) compared to �107.89 ($181) for those who are controlled. 50% of the total cost was attributed to the 22% of patients who experienced an asthma attack. 44% of this groups expenditure was due to hospital admission. The cost of emergency drugs used to treat attacks represented a minor cost when compared with the cost of hospital stay. Treating more of the hospitalised patients within general practice will greatly reduce costs. Relative costs between countries differ but the presentation/referral patterns may be similar and the results show how these can impact on health care costs. The high cost of managing patients who have had an attack highlights the importance of prevention. Given the major burden associated with uncontrolled asthma, appropriate targeting of preventative measures and ensuring good compliance, could reduce overall healthcare costs and growing pressures on hospital services associated with management of asthma.

This study was supported by a grant from Zeneca Pharmaceuticals

For further information on the Asthma Research Unit, please contact:
Tayside Centre for General Practice
University of Dundee
Kirsty Semple Way
Dundee DD2 4BF
Scotland
Tel : +44 (0)1382 420000
Fax :+44 (0)1382 420010
aru@tcgp.dundee.ac.uk

Updated by Mark Stewart: Tuesday, November 6, 2001