Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
Department of Medicine, Little Belt Hospital, Vejle, Denmark.
BMJ Open Respir Res. 2023 May;10(1). doi: 10.1136/bmjresp-2022-001437.
As a common chronic disease seen across all ages, asthma has the potential to incur high societal and individual costs from both direct healthcare costs and loss of productivity. Most previous studies use smaller, selected populations to assess the cost of asthma, possibly reducing generalisability. We, therefore, aimed to assess the total, nationwide economic burden of asthma by severity from both an individual and a societal perspective.
The annual cost of asthma was assessed in a Danish nationwide cohort of patients aged 18-45 during 2014-2016 as excess healthcare costs, loss of income and welfare expenditure compared with controls (matched 1:4) using national registries. Asthma severity was defined as mild-to-moderate (steps 1-3 or step 4 without exacerbations) or severe (step 4 with exacerbations or step 5).
Across 63 130 patients (mean age 33, 55% female), the annual excess cost of asthma compared with controls was predicted to €4095 (95% CI €3856 to €4334) per patient. Beyond direct costs related to treatment and hospitalisations (€1555 (95% CI €1517 to €1593)), excess indirect costs related to loss of income (€1060 (95% CI €946 to €1171)) and welfare expenditure (eg, sick pay and disability pensions) (€1480 (95% CI €1392 to €1570)) were seen. Crude pooling of excess costs resulted in an annual societal cost of €263 million for all included patients.Severe asthma (4.5%) incurred 4.4 times higher net costs (€15 749 (95% CI 13 928 to €17 638)) compared with mild-to-moderate disease (€3586 (95% CI €3349 to €3824)). Furthermore, patients with severe asthma experienced an annual loss of income of €3695 (95% CI €4106 to €3225) compared with controls.
In young adults with asthma, a significant societal and individual financial burden of disease was seen across severities. Expenditure was mainly driven by loss of income and welfare utilisation, rather than direct healthcare costs.
哮喘是一种常见的慢性病，可导致个人和社会产生高额直接医疗费用和生产力损失。大多数先前的研究都使用较小的、选定的人群来评估哮喘的成本，这可能会降低其普遍性。因此，我们旨在从个人和社会角度评估不同严重程度哮喘的全国性经济负担。
在 2014 年至 2016 年期间，使用国家登记处，我们在丹麦全国范围内的 18-45 岁患者队列中评估了哮喘的年度成本，与对照组（1:4 匹配）相比，这些患者的医疗保健费用过高、收入损失和福利支出。哮喘严重程度定义为轻度至中度（第 1-3 步或无恶化的第 4 步）或重度（恶化的第 4 步或第 5 步）。
在 63130 名患者（平均年龄 33 岁，55%为女性）中，与对照组相比，哮喘患者的年超额成本预计为 4095 欧元（95%可信区间 3856-4334 欧元）。除了与治疗和住院相关的直接费用（1555 欧元（95%可信区间 1517-1593 欧元））外，还存在与收入损失相关的间接费用（1060 欧元（95%可信区间 946-1171 欧元））和福利支出（例如病假工资和残疾养恤金）（1480 欧元（95%可信区间 1392-1570 欧元））。直接成本和间接成本的粗略总和导致所有纳入患者的年度社会成本为 2.63 亿欧元。与轻度至中度疾病（3586 欧元（95%可信区间 3349-3824 欧元）相比，重度哮喘（4.5%）的净费用高出 4 倍（15749 欧元（95%可信区间 13928-17638 欧元））。此外，与对照组相比，重度哮喘患者每年的收入损失为 3695 欧元（95%可信区间 4106-3225 欧元）。
在患有哮喘的年轻成年人中，无论严重程度如何，都存在显著的社会和个人疾病经济负担。支出主要由收入损失和福利利用驱动，而不是直接医疗保健费用。
