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The Management of Severe Asthma

Economic Analysis of the Cost of Treatments for Severe Asthma

Michael S. Blaiss, University of Tennessee Health Science Center
Memphis, Tennessee


Severe asthma consumes a disproportionate share of asthma health care resources. We need treatment strategies that minimize exacerbations which may decrease the need for unscheduled medical services, reduced ED visits, and minimize hospitalizations should be cost-effective in asthma care.

Direct Medical Costs-
1) The amount of money spent on medical services directly due to an illness. This includes hospital care, pharmaceutical products, physician care, nursing services, etc.
2) The amount of resources consumed directly to produce a certain outcome such as personnel time, equipment, supplies, etc.

Direct Non-medical Costs-
1) Expenditures outside the medical market such as costs borne by patients seeking care. This includes costs such as transportation, child care, and lodging, etc.

Indirect Costs-
1) Costs resulting from a patient being unable to perform normal activities due to illness and therefore borne by the patient, the patient's family, or an employer.
2) Expenditures or losses as an indirect consequence of illness or consumption of medical care. Examples include lost earnings, decreased productivity.
3) Economic value of changes in health status as measured by lost wages, willingness to pay, or human capital theory.

Intangible Costs-
1) Include humanistic measures of changes in health status such as quality of life and satisfaction.

Costs disproportionately affect those with most severe disease:
severe asthma 50% costs (10% population)
mild asthma 20% costs (70% population)

Medical management can lead to cost savings in severe asthma. Combination therapy with inhaled corticosteroids and long-acting beta agonist has been documented to decrease ED visits and hospitalizations. In severe and difficult-to-treat asthmatics, omalizumab prevented the development of exacerbations in 17 additional patients for every 100 treated. This corresponds to a prevented fraction of 50% in the incidence of exacerbations in patients randomized to omalizumab. In the INNOVATE study (Humbert M, Beasley R, Ayres J et al. Allergy 2005; 60:309-16), omalizumab decreased hospital admission rate to 1 admission for every 8 treated patients per year compared to 1 admission for every 4 placebo patients per year. Further studies are needed to measure economic outcomes in the treatment of severe asthma.

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