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Poorly Controlled Asthmais Costly

Poorly controlled asthma more than doubles healthcare costsassociated with the disease and threatens educational achievement through adramatic increase in school absence, according to researchers at NationalJewish Health. The research team reported in the August 2011 issue of The Archives of Allergy, Asthma &Immunology that children with “very poorly controlled” asthma missed anaverage of 18 days of school each year, compared to 2 or less for other asthmapatients.

“This study looks for the first time at how effective andineffective management of severe asthma impacts cost ,” said Stanley Szefler,MD, lead author and Professor of Pediatrics at National Jewish Health. “Ithighlights the toll that poorly controlled asthma takes on children. It alsopoints to an opportunity – with proper attention and education, many, if notmost, of those children could gain control over their asthma, thus reducinghealthcare costs, improving their lives and their chances for success.”

The researchers studied 628 children ages 6 to 12 withsevere or difficult-to-treat asthma. They evaluated direct medical costs –medications, unscheduled office and emergency visits, and hospital admissions –and indirect costs as measured by school/work days lost. Costs were evaluatedat baseline, 12 months and 24 months. Patients were divided into three groups -very poorly controlled, not well controlled and well controlled asthma,according to NIH guidelines.

Very poorly controlled asthma patients incurred at baselinean average of $7,846 in costs associated with asthma, compared to $3,526 fornot well controlled asthma patients and $3,766 for well controlled asthma. Twoyears out, costs for very poorly controlled asthma patients increased to $8,880while costs for those with well controlled asthma dropped to $1,861. (All costs are in 2002 dollars. Costs in 2011dollars would be approximately 25 percent greater.)

Direct costs of care were roughly 50 percent higher forpoorly controlled asthma at $4,983, compared to $3,236 for not well controlledasthma, and $3,588 for well controlled asthma.

Indirect costs were much greater for poorly controlledasthma as measured by the impact on work and school. Children with poorlycontrolled asthma missed an average of 18 school days per year, compared to 2missed days for poorly controlled asthma, and 0 for the well controlled asthma.

The researchers estimated that one parent would have to stayhome for each missed school day, at an average cost of $172 dollars per day.Indirect costs for very poorly controlled asthma, $3,078, were more than eighttimes as great as the costs for not well controlled asthma, $369. With nomissed school days among well controlled asthma patients, their indirect costswere $0.

The large variance for missed school days suggested anothercost not included in the researchers’ calculations—low educational achievement.They cited a study of 3,812 students in Missouriindicating a much higher chance of failure for those absent an average of 12school days. The very poorly controlled asthma patients in the current studymissed an average of 18 days.

But the researchers also cited another study that suggestedabout 85 percent of asthma patients can bring asthma under control with carefuleducation and supervision. Their data do indicate that improvement in asthmacontrol does reduce asthma-related costs.

“There are effective strategies to improve asthma controlamong children,” said Dr. Szefler. “By addressing medication adherence, inhalertechnique, proper medications, and other asthma management strategies, we couldimprove asthma and reduce costs significantly.”



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