Costs of managing asthma as defined by a derived Asthma Control Test^TMscore in seven European countries

Abstract

The present authors explored the relationship between asthma control status, as measured by a derived Asthma Control Test TM (ACT) score, and the utilisation and cost of healthcare in Europe. Data were derived from a European survey of asthma patients. Frequency of healthcare resource use was identified from the dataset and per-patient mean cost of asthma management estimated. Drug costs were not available. The ACT score was derived from questions in the survey identical or similar to the items comprising the ACT.An ACT score was derived for 2,268 patients, of whom 48% (1,078) scored ,20, suggesting their asthma was not well controlled, with 17% (381) scoring ,15, suggesting poorly controlled asthma. The mean per-patient annual cost of asthma management for patients with a derived ACT of ,15 was J1,604 (95% confidence interval: J1,219-2,084); for patients with a derived ACT score of 15-19, J512 (J404-660) and for patients with a derived ACT score of o20, J232 (J192-286). A higher derived ACT score was associated with significantly lower expenditure on asthma management.Worse asthma control, as measured by the derived Asthma Control Test TM score was associated with an increased requirement for unscheduled care and with higher cost.KEYWORDS: Asthma, asthma control, Europe, healthcare costs A sthma is a chronic inflammatory respiratory disease and is a major cause of morbidity [1]. The prevalence of asthma in Western Europe ranges from 3.9% in Germany to 10.9% in the UK [2]. International guidelines recommend that the aim of asthma management should be to achieve and maintain control [3,4]. The Global Initiative for Asthma (GINA) guidelines define control as minimal (ideally no) chronic symptoms, minimal (infrequent) exacerbations, no emergency visits, minimal (ideally no) need for rescue medications, no activity restriction, peak expiratory flow (PEF) circadian variation ,20%, (near) normal PEF and minimal (or no) adverse effects from medicine [4].However, no consensus exists on the optimum method to assess asthma control in practice. Composite measures used for assessing asthma control include the Asthma Control Questionnaire [5], which has recently been validated in a shortened format that does not require the assessment of lung function [6], and the Asthma Control Test TM (ACT) [7]. The ACT is a reliable and valid patient-completed measure of asthma control that was developed for easy use in a clinical setting [7]. The ACT comprises five items, each relating to an aspect of asthma control over the previous 4 weeks: limitations to activities; shortness of breath; night-time awakening; use of rescue medication and patient perception of control. Completion of the ACT results in a score between 5 and 25, with a higher score indicating better control. A validation study found that an ACT score of o20 indicated ''well-controlled'' asthma, and a score of ,15 ''poorly controlled '' asthma [8]. The ACT has been shown to have a good specificity and sensitivity in identifying patients whose asthma control woul...

The Asthma Control Test (ACT) as an alternative tool to Global Initiative for Asthma (GINA) guideline criteria for assessing asthma control in Vietnamese outpatients

“…These numbers are much higher than those in other studies (6-13.6%), 23,24 including a Vietnamese subgroup in an international study. 23 This may explain why the number of patients with severe asthma in this study is higher than in some other studies, 23,[25][26][27][28] while the rate of patients with controlled asthma in this study is also higher than that in other studies. 23,26,28 This result supports the concept that severity may not be an important index in asthma management.…”

“…23 This may explain why the number of patients with severe asthma in this study is higher than in some other studies, 23,[25][26][27][28] while the rate of patients with controlled asthma in this study is also higher than that in other studies. 23,26,28 This result supports the concept that severity may not be an important index in asthma management. 2 It is clear that 53% of patients in this study had moderate to severe asthma, but their asthma control is good because of their use of preventer therapy.…”

“…2 It is clear that 53% of patients in this study had moderate to severe asthma, but their asthma control is good because of their use of preventer therapy. On the other hand, the proportion of patients with moderate to severe asthma in some other studies is low and the rate of asthma control is also quite low, 23,25,27,28 which may be due to lack of appropriate therapy or a poor response to such therapy.…”

Improving Outcomes for Underserved Adolescents With Asthma

“…However, despite the availability of clinical practice guidelines and efficacious treatment options, [9][10][11][12][13][14] asthma is not well controlled for many patients, 15 and poorer asthma control is associated with higher costs and increased resource use. [15][16][17][18] In addition, large gaps still exist between the care recommended by guidelines and that actually provided, [19][20][21][22][23][24][25][26][27][28] and there is an inadequate focus on self-management. 29 A study from the Rand Corporation published in 2007 showed that adherence to 17 recommended ambulatory care indicators for children with asthma was only 46%.…”

The economic burden of uncontrolled asthma across Europe and the Asia-Pacific region: can we afford to not control asthma?

“…Some of these points are addressed in the articles in this issue of the European Respiratory Review; namely, the use of a validated self-administered measures to assess asthma control, and the potential economic benefit of achieving control of asthma [6][7][8][9].…”