CDC Study Puts Economic Burden of Asthma at More Than $80 Billion Per Year

Asthma costs the US economy more than $80 billion annually in medical expenses, days missed from work and school, and deaths, according to research published online in the Annals of the American Thoracic Society. However, actual numbers are likely to be higher, since the researchers from the CDC only counted “treated asthma,” defined as having at least 1 medical encounter for asthma or having a prescription for at least 1 asthma medicine filled during a calendar year.

The study also did not account for nonmedical costs associated with asthma, including transportation expenses, time lost waiting for appointments, and diminished productivity while functioning at work or school with asthma.

Prescription drug costs were the largest share of per-person medical costs for asthma.

"The cost of asthma is one of the most important measures of the burden of the disease," said Tursynbek Nurmagambetov, PhD, lead study author and CDC health economist, in a statement. "Cost studies can influence health policy decisions and help decision makers understand the scale, seriousness and implications of asthma, so that resources can be identified to improve disease management and reduce the burden of asthma."

In "The Economic Burden of Asthma in the United States, 2008-2013," CDC researchers analyzed data from the Medical Expenditure Panel Survey. Of 213,994 respondents to the survey over a 6-year period, the study identified 10,237 people with treated asthma. Based on the 2008-2013 pooled sample, the study estimated (all costs are expressed in 2015 US dollars):

• About 15.4 million people in the United States had treated asthma each year
• The total annual cost of asthma in the United States, including medical care, absenteeism and mortality, was $81.9 billion
• The annual per-person medical cost of asthma was $3266, of which: $1830 was for prescriptions $640 for office visits $529 for hospitalizations $176 for hospital outpatient visits $105 for emergency department (ED) care
• Asthma-related mortality cost $29 billion per year, representing an average 3168 deaths
• Missed work and school days, combined, cost $3 billion per year, representing 8.7 million workdays and 5.2 million school days
• People with no health insurance had significantly lower per person total medical expenditure for asthma compared with insured people

Children with asthma missed 2.3 additional school days annually during 2008—2013, at a per-child cost of $207. Adults with asthma missed 1.8 days annually, resulting in almost $214 lost earnings per worker annually.

"The findings of the paper highlight the critical need to support and further strengthen asthma control strategies," Nurmagambetov said. "CDC's National Asthma Control Program was founded in 1999 to help reduce the burden of asthma in the United States. In order to reduce asthma-related ER visits, hospitalizations, absenteeism and mortality, we need to support guidelines-based care, expand self-management education and reduce environmental asthma triggers at homes."

Since the analysis was based on treated asthma, the study excluded costs by people with lifetime or current asthma who didn’t use any healthcare service in a given year.

Treated asthma was defined as an office-based medical provider office visit, hospital-based outpatient visit, ED visit, hospital inpatient stay, or a filled prescription asthma medication.

Lifetime asthma was defined as an affirmative response to the question: “Has a doctor or other health professional ever told you that you had asthma?” Current asthma was defined as having lifetime asthma plus an affirmative response to “Do you still have asthma?”

According to the study, in 2013, from about 22.6 million people with current asthma, only 15.5 million had treated asthma—meaning that about 1 in 3 persons with current asthma had no asthma-related encounter with a medical provider or a pharmacy in that year.

People without health insurance may have limited their care (or paid out of pocket) since they had significantly lower incremental medical cost of asthma compared with the population average of $3266.

Other results of the study found:

• Women and blacks were more likely to have asthma
• Married adults were less likely to have asthma
• Among people with asthma, a larger proportion lived in poverty (less than 100% of poverty line) or near the poverty line (from 100% to 125% of poverty line)
• Persons with asthma had a significantly higher Charlson comorbidity index [the most widely used comorbidity index to predict 1-year survival] than did persons without asthma
• The proportion of persons covered by Medicaid was significantly higher in the asthma group than in the non-asthma group (17%)
• Poor people (with incomes less than 100% of poverty threshold) have significantly higher medical costs because of asthma than those with higher incomes
• A smaller proportion of the asthma group (6%) was uninsured, compared with the non-asthma group (18%)
• Persons with asthma were also generally less educated and had lower incomes
• On average, the total unadjusted medical cost of people with asthma was more than twice that of people without asthma

The study also found that blacks and Hispanics have lower medical costs for asthma relative to the population average. Other studies have found that these populations have higher rates of hospitalizations and ED visits associated with asthma but lower rates of asthma prescription medication and outpatient visits. The authors said this could explain their lower total medical cost of asthma, since prescription drugs and outpatient visits are the 2 largest contributors to total medical care costs.

Both indoor and outdoor pollutants are known to trigger asthma, and the authors wrote that environmental interventions to reduce indoor asthma triggers for low-income families have been found to be cost-effective and are encouraged to reduce the burden of asthma.

The authors said the “findings highlight the critical need to support and further strengthen asthma control strategies through increased provision of guidelines-based care, improvements in self-management, and reduction of environmental asthma triggers in order to reduce ER visits, hospitalizations, absenteeism, and mortality.”