Asthma, rhinitis, other respiratory diseases
Trends in the cost of illness for asthma in the United States, 1985-1994,☆☆

https://doi.org/10.1067/mai.2000.109426Get rights and content

Abstract

Background: During the past decade, there have been notable changes in asthma prevalence, morbidity, and mortality. In this same time period, there have also been important national efforts to increase asthma awareness and improve asthma care. Objective: The purpose of this study was to examine the changes in US cost of illness for asthma during the 10-year period from 1985-1994. Methods: The study was a two-period (1985 and 1994), cross-sectional, cost-of-illness analysis. Cost estimates were based on US population and health care survey data available from the National Center for Health Statistics. Results: The total US costs of asthma for 1994 were $10.7 billion. On the basis of 1985 estimates adjusted to 1994 dollars, total asthma costs increased by 54.1% and direct medical expenditures increased by 20.4% during the 10-year period. In 1985, hospital inpatient care represented the largest component cost of direct medical expenditures (44.6%). Hospital inpatient costs decreased to 29.5% of direct medical expenditures in 1994, primarily because of shorter lengths of stay, as opposed to a decrease in the total number of admissions. In 1994, medications represented the largest component cost of direct medical expenditures (40.1%, up from 30.0% in 1985). The largest component increase in indirect costs was due to loss of work. On the basis of adjusted dollars, estimated costs per affected person with asthma declined by 3.4% (decrease of 15.5% for children and an increase of 2.9% for persons 18 years and older) during this time period. Conclusion: Although the US costs of asthma increased during the 1985-1994 time period, estimated costs per person with asthma demonstrated a modest decline. These findings may represent a combination of reductions in hospital lengths of stay and increasing prevalence of persons with low consumption of asthma-related health care resources. In examining the component costs, it is unclear whether these changes can be attributed to the many local, regional, and national efforts aimed at controlling untoward asthma outcomes during the 1985-1994 time period. (J Allergy Clin Immunol 2000;106:493-9.)

Section snippets

Methods

The 1985 cost estimates were obtained from an economic evaluation of asthma published in 1992. To conduct an accurate comparison, it was essential to closely adhere to the previous analytic methods.1 For all health care utilization data, asthma was defined as code 493 of the International Classification of Disease, ninth revision, and was based on a first-listed diagnosis unless otherwise noted. For each estimate of use, morbidity, and mortality, several years of data were averaged to obtain

Direct medical expenditures

In 1994, there were an estimated 477,000 hospitalizations for asthma in the United States, resulting in 1.93 million bed days with an average length of stay of 4.06 days. The resulting inpatient expenditures for asthma are estimated at $1.8 billion (Table I). There were an estimated 1.6 million ED visits at a cost of $478.6 million.

There were an estimated 10.8 million asthma-related visits to private physician’s offices in 1994 at a cost of $647.4 million (Table I). The majority (61.5%) of

Discussion

The total adjusted and unadjusted costs of asthma in the United States increased during the 10-year period from 1985-1994. The total costs of illness increased less among children (age 17 and younger) than among adults. The per person cost of asthma for children decreased during the 10-year period while increasing slightly for adults.

Changes in the costs of asthma during the 10-year period must be interpreted in view of the changes in asthma morbidity and the secular trends in health care use

Acknowledgements

We thank Tom Hodgson, PhD, for providing insights into the study methods; Dorothy Rice for providing current tables on lifetime earnings, without which it would have been difficult to produce current estimates of indirect costs; David Smith, PhD, for providing estimates of current costs from the 1987 National Medical Expenditure Survey; and Ms Robin Wagner for assisting in manuscript development and preparation.

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    Supported in part by an educational grant from the Asthma and Allergy Foundation of America (AFFA).

    ☆☆

    Reprint requests: Kevin B. Weiss, MD, Director, Center for Health Services Research, Rush Primary Care Institute, Rush-Presbyterian-St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, IL 60612.

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