Introduction

What is the cost of an asthma attack (defined as an episode of increased respiratory symptoms prompting an urgent consultation leading to increased use of anti-asthma medication and resulting in a loss of time from work, school or play)? To the patient it means social and economic limitation. To the health service, an increasing drain on finite resources. The patient deserves the most appropriate treatment. The health service needs to know where to focus resources. A large part of the cost of asthma management is the cost of treating attacks¹. To begin to reduce this cost detailed economic appraisal is necessary.

Asthma is a good marker condition for the study of health care economics because it affects all ages, has a wide spectrum of severity, is managed in both primary and secondary care and the outcome of an attack is influenced by medical intervention. A UK wide correspondence survey on the management of asthma attacks² presented an opportunity to prospectively collect data on health service resource use for various types of management. Preliminary costings focusing on where attacks were managed showed that management of an attack solely in primary care with a mean of 2 consultations and one follow up appointment was £25.31, GP referred admission to hospital was £430.38, and GP referred Accident & Emergency £60.87. A more detailed analysis including the cost of drugs was subsequently undertaken and is reported here.

Aim

To use the correspondence survey resource data and published unit cost data to estimate the health service cost of managing an asthma attack.

Method

Participating general practitioners supplied data on the following:

Form of Management

• treated soley in primary care

• treated by the GP, reerred to A&E and discharged

• treated by the GP, referred and admitted to hospital

• treated only in secondary care

Resource Use

• number of GP consultations during attack

• hospital units which provided treatment

• drugs used during attack

• length of stay in hospital

• follow up appointments

Published unit costs were applied to value resource use for each individual patient.  To reflect uncertainty of unit costs High and Low costs were employed.

Results

290 general practitioners supplied details on 2275 patient attack episodes within a specified period. 1204(53%) patients were from rural practices, 1748(77%) from practices with an asthma clinic, 1024(45%) were on no preventative medication pre-attack, the average length of an attack was between 2 and 3 days, and URTI was the precipitating cause in 1469(65%) attacks. Additional information including severity, medication pre-attack, where the attack was managed and treatment given during the attack was provided.

Conclusion

Delay in prescribing any or adequate anti-inflammatory medication impairs bronchial responsiveness and potential to reverse airflow obstruction. If asthma attacks are to be prevented then patients must be treated appropriately. Although a range in the cost of managing an asthma attack has been highlighted the study shows that attacks cost a considerable amount of money and local health authorities may be under-estimating the cost of treatment. The data has a role in assessing the cost of preventative therapies and could be incorporated into evaluation of new drugs. Given the major cost burden of asthma attacks it is possible that a modest investment in increased use of preventative therapy in primary care could greatly reduce the economic burden imposed upon secondary care while improving patients lives.

This study was financed by a grant from Zeneca Pharmaceuticals.

¹Weiss K B, Gergen P J, Hodgson T A. "An economic evaluation of asthma in the US".
The New Eng. J of Med. 1992; 326: 862-866.
²Neville RG, Hoskins G, Smith B, and Clark RA. "How General Practitioners manage acute asthma attacks".
Thorax1997; 52: 153-156