BackgroundAsthma, one of the most common chronic respiratory diseases, affects about 3 million Canadians. The objective of this study is to provide a comprehensive evaluation of the published literature that reports on the clinical, economic, and humanistic burden of asthma in Canada.MethodsA search of the PubMed, EMBASE, and EMCare databases was conducted to identify original research published between 2000 and 2011 on the burden of asthma in Canada. Controlled vocabulary with “asthma” as the main search concept was used. Searches were limited to articles written in English, involving human subjects and restricted to Canada. Articles were selected for inclusion based on predefined criteria like appropriate study design, disease state, and outcome measures. Key data elements, including year and type of research, number of study subjects, characteristics of study population, outcomes evaluated, results, and overall conclusions of the study, were abstracted and tabulated.ResultsThirty-three of the 570 articles identified by the clinical and economic burden literature searches and 14 of the 309 articles identified by the humanistic burden literature searches met the requirements for inclusion in this review. The included studies highlighted the significant clinical burden of asthma and show high rates of healthcare resource utilization among asthma patients (hospitalizations, ED, physician visits, and prescription medication use). The economic burden is also high, with direct costs ranging from an average annual cost of $366 to $647 per patient and a total annual population-level cost ranging from ~ $46 million in British Columbia to ~ $141 million in Ontario. Indirect costs due to time loss from work, productivity loss, and functional impairment increase the overall burden. Although there is limited research on the humanistic burden of asthma, studies show a high (31%-50%) prevalence of psychological distress and diminished QoL among asthma patients relative to subjects without asthma.ConclusionsAs new therapies for asthma become available, economic evaluations and assessment of clinical and humanistic burden will become increasingly important. This report provides a comprehensive resource for health technology assessment that will assist decision making on asthma treatment selection and management guidelines in Canada.

The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.

The use of standard OSD definition across research would allow for comparisons between studies and for improved OSD prevalence estimates. In Australia, 39% of patients with glaucoma were found to have significant (moderate/severe) OSD, and the associated economic burden was AU$330.5 million per annum. Additional research evaluating quality of life and assessing actual direct/indirect OSD costs in the Australian population is warranted.

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The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost-effectiveness of various primary care-based case detection strategies for COPD. Methods: A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost-effectiveness of 16 case detection scenarios. In these scenarios, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3-or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guidelinebased inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are reported in 2015 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. Results: Compared to no case detection, all 16 case detection scenarios had an incremental cost effectiveness ratio (ICER) below a $50,000/QALY willingness to pay threshold in the reference case analysis. In the most efficient scenario, all patients $40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $180 per eligible patient, and an incremental effectiveness of 0.009 QALYs per eligible patient, resulting in an ICER of $21,108/QALY compared to the CDQ delivered to ever smokers at 5-year intervals, which was the next most highly-ranked scenario on the efficiency frontier. Results: were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. When this was not associated with a utility benefit, case detection was no longer cost-effective. Conclusions: Primary care-based case detection programs for COPD are likely to be cost-effective if adherence to best-practice recommendations for treatment is high.