Association between asthma control and asthma cost: Results from a longitudinal study in a primary care setting

Abstract

Background and objective: Asthma control can be assessed with the Asthma Control Test (ACT) and a score of 20 or higher indicates good asthma control. Patients pay for their consultation and treatment in the fee-for-service primary healthcare system in Singapore. We hypothesized that achieving asthma control would result in lower asthma costs through reduced acute exacerbations, fewer physician consultations and lower lost productivity. The study compared the healthcare costs of patients who achieved asthma control and those with suboptimal asthma control based on ACT scores. Factors influencing asthma control and healthcare expenditure over time were also examined. Methods: A total of 736 patients were enrolled into an asthma care programme in two polyclinics during 2008 and 2013. Direct costs of asthma management were derived from the frequency of polyclinic consultations, medication costs and hospitalization. Indirect costs were estimated from lost workdays due to exacerbations. The generalized estimating equation (GEE) approach was used to longitudinally model the factors associated with total healthcare expenditure. Results: Patients with asthma control spent S$48 (US $36) more per doctor visit on asthma drugs (P < 0.01) but incurred S$65 (US$48) less per doctor visit in total costs (P < 0.01) than those with suboptimal asthma control. The savings from achieving asthma control for obese patients were greater than for normal-weight patients (S$42 or the equivalent of US$31; P < 0.05). Conclusion: Optimal asthma control was associated with reduced healthcare costs. An effective treatment regimen should also consider other modifiable factors such as weight control to achieve asthma control and eventually reduce asthma costs.

Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review

“…In total, six studies reported on costs [50,65,70,[76][77][78], of which five reported relationships between asthma control subgroup and direct medical costs [50,65,70,76,77], and three with indirect medical costs [65,77,78]. However, only one study reported statistically significant results for direct medical costs [77].…”

The projected economic and health burden of uncontrolled asthma in the United States

“…Further, different studies have used different definition of asthma control (e.g., based on cut-offs on the ACT test or symptom control as defined by Global Initiative for Asthma). While we attempted to use a consistent definition of control, the availability of evidence forced us to relax this assumption at times; for example, in estimating the association between outcomes and controlled levels, we considered other definitions of asthma control ,such as Global Initiative for Asthma(GINA) and National Asthma Education and Prevention Program (NAEPP) as equivalent of ACT in three studies (8,34,35).…”

“…Achieving asthma control is associated with improvement in quality of life, reduction in medical costs, and better work performance (7,8). Unfortunately, the reality of asthma care is highlighted by poor adherence to treatments and other disease management modalities (e.g., avoidance of triggers), resulting in a significant proportion of asthma patients experiencing suboptimal asthma control (9).…”

Practice Patterns for Chronic Respiratory Diseases in the Asia-Pacific Region: A Cross-Sectional Observational Study

“…Admittedly, medication costs were greater for patients with asthma and COPD visiting specialists versus GP. However, prior work suggests that patients with good asthma control may incur greater drug costs, but optimal asthma control is associated with lower overall asthma-related costs than suboptimal asthma control [42]. Criteria for referral to specialists are important components to include in practice guidelines [43].…”