Outcomes in Pediatric Asthma
Understanding the economic burden of asthma,☆☆,

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Abstract

The economic impact of asthma is large and growing, and the use of economic outcomes is increasing. Such outcomes serve as the basis for studies of the efficiency of care and are being reported increasingly as outcomes of clinical trials. This article presents the basic components of a cost-of-illness study, the in-fluences that have an impact on these components, the relation of economic indicators to clinical outcomes, and the relative importance of the economic factors for differing groups in society. (J Allergy Clin Immunol 2001;107:S445-8.)

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Definition

There are 2 types of cost-of-illness studies: prevalence (the most commonly used) and incidence. In a prevalence cost-of-illness study, the cost of an illness in a population is measured over a defined period of time, usually a year. Both incident (new) and prevalent (pre-existing) cases are included in this type of analyses. The data available in most administrative databases and government surveys lend themselves to prevalence types of analyses. In an incidence cost-of-illness survey, only

Direct costs

Direct costs include both medical and nonmedical expenses associated with the disease. Medical direct costs include those expenses generated in the disease’s prevention, treatment, and rehabilitation. Examples include hospital services, physician services, medications, and diagnostic tests. Nonmedical direct costs include such things as transportation to and from the health provider and purchase of home health care such as wheelchairs, nebulizers, special diets, and help in the home. Other

Indirect costs

Indirect costs measure a different aspect of the impact of asthma. Indirect costs are sometimes called opportunity costs and are the value of resources lost as a result of time absent from work or other usual daily activity as a result of illness. Hodgson6 defined indirect costs as “output lost because of cessation or reduction of productivity due to morbidity or mortality.” Indirect costs include days missed from work, including both outside employment and housework, school days lost

Relative importance of direct and indirect costs

Both direct and indirect costs are important contributors to the total cost of asthma (Table III).

. Relative importance of direct and indirect costs: All ages

Empty CellDirect (%)Indirect (%)
Mortality included in indirect costs
 United States (Weiss)58.641.4
 Canada (Krahn)
  Low5941
  High61.138.9
Mortality not included in indirect costs
 United States (Smith)88.411.6
 New South Wales, Australia (Mellis)7723
 Switzerland (Szucs)6139
 Singapore (Chew)50.849.2

Data from: Weiss KB, Gergen PJ, Hodgson TA. N Engl J Med

Cost as outcome

Both direct and indirect costs have a very important role to play in outcomes research. It is important, however, to understand the limitation of economic outcomes. Significant cost savings can be realized without changing the clinical course of the disease. For example, a study looking at the impact of an asthma intervention based on peak flow monitoring found a reduced emergency department use among members of the intervention group, resulting in a significant cost savings. Yet other

Conclusions

The importance of economic outcomes will continue to grow in the foreseeable future. They will be used for 2 reasons: to determine whether an effective treatment is also a cost-efficient treatment and to allow government and health care delivery organizations to ensure appropriate use of resources. It should always be kept in mind that a positive economic outcome is not necessarily synonymous with a positive clinical outcome.

Many factors influence the economic impact of an illness, such as

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    This paper does not represent the policy of AHRQ. The views expressed are those of the authors and no official endorsement by AHRQ is intended or should be inferred.

    ☆☆

    Dr. Gergen has no significant financial relationship or interest in Merck & Co. He has prepared this report to present factual, unbiased information and attests that no commercial association has influenced this report, nor does this publication constitute a commercial or personal conflict of interest.

    Reprint requests: Peter J. Gergen, MD, MPH, Center for Primary Care and Research, Agency for Healthcare Research and Quality, 6010 Executive Blvd, Suite 201, Rockville, MD 20852.

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