The health and economic burden of breathlessness, Australia, 2019: a national survey

Abstract

ObjectiveTo examine the impact of breathlessness on quality of life, health care use, productivity loss, and economic costs in Australia.Study designNational internet‐based survey of Australian adults drawn from a web‐based survey panel (National Breathlessness Survey).Participants, settingAustralian adults (18 years or older), nationally representative by age group, gender, state of residence, and postcode‐based socio‐economic status (Index of Relative Socioeconomic Disadvantage quintile), 13–30 October 2019.Main outcome measuresQuality of life assessed with the EQ‐5D 5‐level version (EQ‐5D‐5L) and visual analogue scale (EQ‐VAS), health care use, productivity loss, and societal cost, each by severity of breathlessness (modified Medical Research Council [mMRC] dyspnoea scale; mMRC grade 1: mild breathlessness; mMRC grades 2–4: clinically important breathlessness).ResultsOf 10 072 adults who completed the survey, mild breathlessness was reported by 3044 respondents (30.2%), and clinically important breathlessness by 961 (9.5%). The mean EQ‐VAS score was 74.8 points (95% confidence interval [CI], 74.3–75.3 points) and the mean EQ‐5D‐5L score 0.846 (95% CI, 0.841–0.850) for respondents with mMRC grade 0 breathlessness; for each measure, the mean value declined with increasing severity of breathlessness (trends: each P < 0.001). Respondents with clinically important breathlessness were more likely than those with mild breathlessness to report non‐urgent general practitioner visits, urgent general practitioner visits, and specialist visits (exception: mMRC scores of 4) during the preceding year. Among the 2839 respondents of working age, the likelihood of being employed declined with increasing breathlessness severity (mMRC grades 4 v 1: adjusted odds ratio, 0.34; 95% CI, 0.22–0.53). Adjusted mean annual societal cost per person was $1413 (95% CI, $1326–1501) for respondents with mMRC grade 1 breathlessness, $2065 (95% CI, $1766–2365) at mMRC grade 2, $1795 (95% CI, $1371–2218) at mMRC grade 3, and $2075 (95% CI, $1389–2762) at mMRC grade 4.ConclusionBreathlessness imposes major burdens on individuals, the health care system, and the economy.