The association between asthma control, health care costs, and quality of life in France and Spain

Abstract

BackgroundCurrent asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.MethodsAn observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.Results2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).ConclusionsIn both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain

“…In Spain, the average cost (euros/3 months/patient) of controlled asthma was €152.60, increasing steadily to €241.20 and €556.80 in partly controlled and uncontrolled patients. Asthma medication was the main driver of the direct costs for controlled and partly controlled disease, whereas costs associated with hospitalizations for asthma and emergency room visits were higher in uncontrolled asthma patients [30]. In the present study, the cost-effectiveness analysis showed that adding FeNO testing to standard guideline care resulted in savings of €62.53 per patient-year compared with standard guideline-directed care alone (Table 3).…”

Prevalence of Asthma Bronchiale in the Czech Republic and its Economic Burden

“…350 million patients worldwide (Aldubi et al, 2015;Bahadori et al, 2009;Busaidi-Al et al, 2013;D'Amato et al, 2015;Litonjua and Weiss, 2007). Prevalence of this disease is steadily increasing, particularly in industrial countries and in some European countries is already higher than 10% of infantile population (Litonjua and Weiss, 2007;Bedouch et al, 2012;Doz et al, 2013;Kasak, 2005;Negro et al, 2007). This trend is very similar in the Czech Republic, particularly in the infantile population (Kasak, 2005;Petru, 2008;Pohunek and Slamova, 2009;Pohunek et al, 2009).…”

“…Problems in evidence of AB, leading to disproportional evidence of AB in individual regions, are also significant (Gudelj et al, 2012;Hansen et al, 2012). An exact and early diagnosis can significantly reduce progression of clinical manifestation of AB and thus strongly lower financial burden (Bahadori et al, 2009;Litonjua and Weiss, 2007;Edwards et al, 2011;Doz et al, 2013;Pohunek et al, 2009).…”

“…This trend is very similar in the Czech Republic, particularly in the infantile population (Kasak, 2005;Petru, 2008;Pohunek and Slamova, 2009;Pohunek et al, 2009). Despite the fact that in recent years there is considerable attention focused on diagnostic of all allergic diseases including AB, a full and precise diagnosis is still often unsatisfactory, with subsequent problems starting treatment at the earliest start of this disease (Bedouch et al, 2012;Doz et al, 2013;Pakhale et al, 2011;Petru, 2008;Pohunek et al, 2009;Zhang et al, 2015). Problems in evidence of AB, leading to disproportional evidence of AB in individual regions, are also significant (Gudelj et al, 2012;Hansen et al, 2012).…”

Health-related quality of life of patients with asthma: a cross-sectional study in Semnan, Islamic Republic of Iran

“…Several factors could affect QoL of people with asthma, such as age, socioeconomic status, education level and marital status. These factors could modify classification, diagnosis and treatment of asthma (14). Despite the importance of assessing QoL in chronic respiratory diseases such as asthma, there has been limited research on QoL in people with asthma in the Islamic Republic of Iran.…”