Asthma Research Unit - Research Poster

To assess the impact of poorly controlled asthma on overall healthcare by comparing resource use of those children less than 12 years who suffer ‘attacks’ with those who do not.

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 2,770 patients under the age of 12 years (61% 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.

Resource use for those who did & did not have an attack
Table 1	Attack n=707	No Attack n=2063
Number of:
Patient initiated GP consultations	2006	2543
Patient initiated nurse consultations	241	471
Practice GP reviews	704	931
Practice Nurse reviews	1119	2593
Number of patients given:
Systemic steroids	421(60%)	68(3%)
Emergency bronchodilators	265(37%)	22(1%)
Prophylactic Medication	651(92%)	1424(69%)
Number of patients who attended:
Accident & Emergency (ER)	110(16%)	21(1%)
Hospital Admission	124(18%)	12(1%)
Outpatients	119(17%)	111(5%)

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=707)	95% confidence interval	Had no attack (n=2063)	95% confidence interval
Patient initiated GP consultations	40 941	25.54	23.99 to 27.09	11.09	10.44 to 11.74
Practice initiated GP consultations	22 890	13.94	12.18 to 15.71	6.32	5.72 to 6.91
Patient initiated nurse consultations	4 272	2.05	1.68 to 2.40	1.37	1.18 to 1.56
Nurse review	22 272	9.50	8.63 to 10.36	7.54	7.15 to 7.93
Systemic steroids	702	0.87	0.79 to 0.94	0.04	0.03 to 0.06
Emergency bronchodilators	121	0.16	0.14 to 0.19	0.003	0.0017 to 0.0042
Drugs	173 592	90.41	80.86 to 99.96	53.16	49.25 to 57.07
A&E (ER) visits	9 978	12.27	9.42 to 15.11	0.63	0.34 to 0.93
Hospital stay	108 349	140.12	105.86 to 174.38	4.50	1.44 to 7.56
Outpatients	42 264	34.91	25.56 to 44.25	8.52	6.74 to 10.31
Total	425 381	329.77	286.91 to 372.59	93.17	87.32 to 99.06

The average annual cost of treating children with unstable asthma is �329.77 compared to �93.17 for those who are more controlled. 55% of the total cost was attributed to the 26% of children who experienced an asthma attack. 42% of this group’s expenditure was due to hospital admission. The cost of emergency drugs used to treat attacks represented a negligible cost when compared with the cost of hospital stay. Treating more of the hospitalised children within general practice will greatly reduce costs. The high cost of managing children 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.