Identifying Asthma’s Costs: A Cross-Sectional Analysis of the Direct and Indirect Costs
Introduction
Asthma, one of the most prevalent respiratory diseases globally, is characterized by symptoms like coughing, wheezing, and difficulty breathing, along with clinical exacerbations which are acute deteriorations of these symptoms requiring additional treatment (Fabbri et al., 2017). These exacerbations not only disrupt daily life but also significantly diminish the quality of life (QoL) and incur substantial costs.
A key factor in the escalation of asthma-related healthcare expenses is the lack of adherence to prescribed treatment plans (Davis et al., 2017; Mäkelä et al., 2013). The management landscape is evolving towards more patient-centered approaches, like home-based and virtual care, to provide more accessible solutions.
The Burden of Asthma
In the U.S., asthma affects an estimated 7.8% of the population, or 26 million people, including 8.4% of adults (Centers for Disease Control and Prevention, 2020). Asthma-related mortality is significant, with an average of ten deaths per day in the U.S. In 2020, 4,145 deaths were recorded due to asthma, with an adult death rate of 15.4 per million (Centers for Disease Control and Prevention, 2022).
Clinical exacerbations, the main reason for emergency department (ED) visits and hospitalizations, impact around 40% of adult asthma patients and over 50% of children annually (Asthma and Allergy Foundation of America, 2023). The American Thoracic Society, analyzing data from 2008 to 2013, reported that the annual cost of asthma in the U.S. (including direct and indirect expenses) exceeded $80 billion in 2015 dollars (American Thoracic Society, 2018; Nurmagambetov et al., 2018).
Direct and Indirect Costs of Asthma: An Overview
Direct Costs of Asthma: Hospitalizations, ED Visits, and Readmission Rates
The economic burden of asthma is substantial. According to the American Thoracic Society, the overall direct medical costs from 2008 to 2013 exceeded $50 billion. Individuals with treated asthma incurred an average annual cost of $3,266 per person in 2015 USD, with prescriptions constituting $1,830. This cost included $640 for office visits, $529 for hospitalizations, $176 for hospital-based outpatient visits, and $105 for emergency department (ED) care (Nurmagambetov et al., 2018).
Asthma significantly increases healthcare utilization. In the U.S., approximately 9.8 million outpatient visits annually are attributed to asthma (Centers for Disease Control and Prevention, 2022; Song et al., 2020). The condition is linked to increased hospitalizations, ED visits, and 30-day hospital readmission rates (AL-Jahdali et al., 2012; Bollmeier & Hartmann, 2020). Notably, in 2019, asthma accounted for 108.4 ED visits per 10,000 children and 41.8 for adults, and 9.7% of all U.S. ED visits in 2020 (Centers for Disease Control and Prevention, 2020; National Center for Health Statistics, 2020). The American Lung Association reported a hospitalization rate of 5.2 per 10,000 for asthma patients (American Lung Association, 2023), with the CDC documenting 169,330 inpatient stays in 2019 (Centers for Disease Control and Prevention, 2022). The direct costs for those with an asthma diagnosis are significantly higher, ranging from $3,305 to $9,175 annually, depending on the severity, and are 78.3% to 88.5% higher than those without asthma (Song et al., 2020).
The 30-day readmission rates for asthma are notably high at 11.9%, indicating a significant area for cost reduction and healthcare improvement (Shah et al., 2015).
Indirect Costs of Asthma
The indirect costs of asthma, such as lost productivity, also escalate with the severity of the disease. Patients with asthma, on average, incur additional indirect costs ranging from $106 to $1,000 annually compared to non-asthmatic individuals. This includes more missed school and work days—about 2.3 more school days and 1.8 more work days for those with asthma (Nurmagambetov et al., 2018). The total cost of absenteeism due to asthma in the United States is estimated at $42 million (Chan, 2019).
Asthma imposes a significant financial burden on both direct medical expenses and indirect costs due to lost productivity. These findings highlight the need for effective asthma management strategies to mitigate these costs and improve patient outcomes.
Strategies for Cost Reduction
Effective asthma management is crucial for reducing healthcare costs. Integrating at-home care approaches and self-management strategies has shown promise. Proper treatment and care can prevent exacerbations, hospitalizations, ED visits, amnd improve QoL, significantly reducing both direct and indirect costs. Research highlights the effectiveness of interventions that maximize bronchodilation and combine patient education with comprehensive disease management (Bollmeier & Hartmann, 2020; Maltby et al., 2020; McClatchey et al., 2023; McDonald et al., 2022; Pinnock et al., 2017).
The CDC has recognized asthma as one of six particularly costly health conditions with proven interventions (Centers for Disease Control and Prevention, 2018b). These interventions include adherence to National Asthma Education and Prevention Program (NAEPP) Guidelines, improving access to medications and devices, enhancing self-management education, and expanding access to home visits (Centers for Disease Control and Prevention, 2020a; Cloutier et al., 2009).
Innovations in Virtual Care: Nightingale VIrtual Respiratory Care
Health Care Originals (HCO) has introduced the Nightingale Virtual Respiratory Care Program, a cutting-edge approach that focuses on helping patients independently manage their respiratory conditions. A key feature of Nightingale is the ADAMM-RSM device. This device is exceptional because it tracks respiratory patterns in detail and shares this data in real time with healthcare providers, enhancing patient care (Fan et al., 2020). Additionally, it uses advanced algorithms that can predict exacerbations up to three months in advance (Rhee et al., 2015).
The Nightingale Program has been successful in improving symptoms for those with respiratory issues. This success is measured using the SGRQ (St. George’s Respiratory Questionnaire), which scores symptoms on a scale from 0 to 100, where higher scores mean more severe symptoms. Initially, the average score was 64, but after six months in the program, it dropped by 18 points to 46. For participants enrolled for a year, the score decreased by 28 points to 36, showing a significant improvement in symptoms.
Asthma has a considerable economic impact through direct and indirect costs. Programs like Nightingale, with their innovative and effective management strategies, are vital in reducing these costs and enhancing the well-being of patients with respiratory conditions.
