Weiss K B, Gergen P J, Hodgson T A
Department of Health Care Sciences, George Washington University Medical Center, Washington, DC 20037.
N Engl J Med. 1992 Mar 26;326(13):862-6. doi: 10.1056/NEJM199203263261304.
Asthma is a common chronic illness. Recently, increases in morbidity and mortality due to this disease have been reported. We studied the distribution of health care resources used for asthma in order to lay the groundwork for further policy decisions aimed at reducing the economic burden of this disorder.
Estimates of direct medical expenditures and indirect costs (in 1985 dollars) were derived from data available from the National Center for Health Statistics. These cost estimates were projected to 1990 dollars.
The cost of illness related to asthma in 1990 was estimated to be $6.2 billion. Inpatient hospital services represented the largest single direct medical expenditure for this chronic condition, approaching $1.6 billion. The value of reduced productivity due to loss of school days represented the largest single indirect cost, approaching $1 billion in 1990. Although asthma is often considered to be a mild chronic illness treatable with ambulatory care, we found that 43 percent of its economic impact was associated with emergency room use, hospitalization, and death. Nearly two thirds of the visits for ambulatory care were to physicians in three primary care specialties--pediatrics, family medicine or general practice, and internal medicine.
Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.
哮喘是一种常见的慢性病。最近，有报道称该疾病的发病率和死亡率有所上升。我们研究了用于哮喘的医疗资源分布情况，以便为进一步制定旨在减轻该疾病经济负担的政策奠定基础。
直接医疗支出和间接成本（按1985年美元计算）的估计值来自国家卫生统计中心提供的数据。这些成本估计值被推算至1990年美元。
1990年与哮喘相关的疾病成本估计为62亿美元。住院医院服务是这种慢性病最大的单项直接医疗支出，接近16亿美元。因缺课导致的生产力下降所造成的损失是最大的单项间接成本，在1990年接近10亿美元。尽管哮喘通常被认为是一种可用门诊治疗的轻度慢性病，但我们发现其43%的经济影响与急诊室使用、住院治疗和死亡有关。近三分之二的门诊就诊是去看三个初级保健专科的医生——儿科、家庭医学或普通科以及内科。
通过更仔细地审视与各类成本相关的医疗效果，有可能确定美国与哮喘相关成本的潜在降低幅度。未来改善哮喘门诊初级保健干预效果的卫生政策努力可能会降低这种常见疾病的成本。
