Estimated cost of asthma in outpatient treatment: a real-world study.

OBJECTIVE: To estimate the cost of diagnosis and treatment of asthma. METHODS: We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS: The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS: Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

Estimated cost of asthma in outpatient treatment: a real-world study / Estimativa de custo da asma em tratamento ambulatorial: estudo com dados de mundo real

ABSTRACT OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

RESUMO OBJETIVO Estimar o custo do diagnóstico e tratamento da asma. MÉTODOS Foi utilizada a perspectiva da sociedade. Foram incluídos por 12 meses em 2011-2012, sequencialmente, 117 indivíduos maiores de cinco anos de idade, em tratamento por asma nos Serviços de Pneumologia e Alergia-Imunologia da Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro. Todos realizaram duas entrevistas com seis meses de intervalo para coleta de dados, cobrindo 12 meses. As unidades de custos foram identificadas e valoradas de acordo com métodos definidos. Foi feita análise de sensibilidade e foram aplicados métodos estatísticos com nível de significância de 5% para comparações de custos entre subgrupos. RESULTADOS Cento e oito pacientes completaram o estudo, 73,8% eram mulheres. Mediana de idade foi de 49,5 anos. Rinite esteve presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade. A renda familiar média foi de R$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença.

Asthma and the socio-economic reality in Brazil.

BACKGROUND: Asthma is a prevalent disease that is considered a health problem worldwide. The aim of this study was to analyze the clinical and socioeconomic characteristics of a cohort of asthmatics receiving specialized outpatient treatment in a tertiary/teaching public hospital in Brazil. METHODS: Persistent asthmatics older than 5 years old were consecutively included. They received clinical treatment at 3- to 4-month intervals and were interviewed 2 times at 6-month intervals over a 12-month observation period. The data were collected directly from the patients or their parents by 2 researchers who did not participate in their clinical care. The primary variables were age, gender, education level, monthly family income, place of residence, number of lost days of school or work, BMI, the severity and control level of asthma, the number of scheduled and non-scheduled visits and hospitalization days and the best peak-flow measurement. RESULTS: Of the 117 participants, 108 completed the study. Of the participants, 73.8% were women, and 25.0% lived outside the county. Of those who lived within the county, 60.1% lived in areas far from the health care unit. The majority (83.3%) had associated rhinitis, and more than 50.0% were overweight or obese, in whom the prevalence of severe asthma was greater (p = 0.001). The median monthly income was US$ 536.58 and was greater among the patients with controlled asthma (p = 0.005 and p = 0.01 at the start and the end of the study, respectively). In the initial evaluation, 16 participants had severe asthma, and in the final evaluation, 8 out of 21 patients with uncontrolled asthma had improved. Three-quarters of the students and half of the workers had missed days of school or work, respectively. The asthmatic population in this study had medium to low socioeconomic status in Brazil and socioeconomic status was associated with overweigth/obesity and with poor control of asthma. CONCLUSION: Asthma has a great impact on absenteeism in Brazil. Lower monthly family income and body weight above the ideal level were associated with greater severity and worse control of asthma.