Economic burden from Asthma in India and USA

By Yashika Kapoor and Priya Chetty on March 20, 2018

Asthma presented substantial global burden, affecting 358.2 million people in 2015. A complex disease, it impairs the social, physical and psychological well-being of the affected. Furthermore, the asthmatic condition can be differentiated into controlled, partially controlled and uncontrolled. The differentiation finds its basis in the level of severity of clinical manifestations (Koshak, 2007). With respect to which the Global asthma report 2014 mentions the higher economic burden associated with the uncontrolled condition (The Global Asthma Network, 2014). Besides the level of manifestation, the level of development also finds an association with disease economic burden. In an attempt to bring out the economic burden borne by developing and developed regions, the discussion presents the case of USA and India.

Global economic burden from Asthma

Recent global scale study by the Global Burden of Disease 2015 revealed that between 1990 and 2015, asthma prevalence increased globally by 12.6%, while deaths from the disease fell by 26.2% (Chronic Respiratory Disease Collaborators, 2015). As emphasized previously, the unique interaction between environmental and host factors influences prevalence. As a consequence, the variables determining the economic burden also vary, accompanied by the level of the healthcare system. However, a mean cost per patient per year has been put forward by different studies. This has allowed us to gain a global perspective, but with considerable gaps. In 2011, costs for treatment of asthma in the USA amounted to $USD 56 billion and the European figures estimated an expenditure of €4.3 billion (Nunes et al. 2017). The Chinese expenditure on asthma in 2014 was found to be $18.80 million (Cai et al. 2014).

However, a study of small sample size (117) from Brazil found mean asthma cost for per patient per year of US$ 882.37 (Costafsilva et al. 2015). Besides the economic costs, social costs such as mortality is another adverse impact of the disease. Although asthma mortality is still uncommon and preventable, with higher instances seen amongst older adults. Hospital admissions are yet another indicator of the disease burden. It also presents a unique problem of variation in admission rates, which correlates to the changes in prevalence.

Economic burden from Asthma in India

India inhabits 1/10th of the total asthmatics in the world. As per the latest reports, the asthmatics in India continue to be choked, not only by the disease condition but due to the economic burden. Asthmatic medication sales have shown a boom in prices by 43% over the course of 4 years (2012-2016) (Sharma 2017). Therefore, it becomes essential to investigate the economic burden faced by asthmatic Indians. However, one major limitation preventing an in-depth analysis is the lack of sufficient literature. There is lack of a national database presenting prevalence and economic figures. Moreover, clinical studies which investigate the issue of economic burden tend to study only small sample sizes. These small sample sizes render the results incapable of being applicable to the overall population.

The study of economic burdens by Murthy & Sastry (2016) presents substantial information about economic burden of asthma in India. The researchers assimilate the data, from different published sources and use guidelines for treatment of asthma as the standard. The table below shows the current cost of treatment of asthma, which indicates the economic burden of the disease in India. Also, the probable cost of treatment of asthma as per the data from Monthly Index of Medical Specialities is shown. Evidently, the cost of treating asthma could be reduced substantially, if the treatment is carried as per the procedures recommended in guidelines.

Year
Current cost of treatment of asthma (INR/patient) per year
Cost of treatment of asthma (INR/case/year) as per the Guidelines
Chronic: MildChronic: Moderate to severeChronic: MildChronic: Moderate to severe
199630311,2502771852
200143616,2004002640
200656921,1415223447
201170226,0876444253
201683531,0457625060

Table 1: Current and calculated costs for asthma treatment

Also, the trend shows a continuous increase in chronic asthma cases since 1996. In 2016, 73.27 lakh people in urban areas and 277.49 lakh in rural areas were suffering from chronic asthma. The rural areas also exhibit higher burden for additional costs, as seen from the rural expenditure of 308.26 crores vs. 111.32 crores in urban areas.

Economic burden from Asthma in the USA

The foremost difference between developing India and developed USA is the availability of data. Different authorities such as Centers for Disease Control and Prevention, American Academy of Allergy, Asthma and Immunology and others maintain the asthma surveillance data at both national and state level. Rappaport & Bonthapally (2012) reports direct and indirect costs of asthma treatment in the USA for the year 2007.  The total cost of illness amounts to $57.28 billion. The patients suffering from asthma have to bear 75% higher direct health expenditures. The total direct costs amount to $43.57 billion, with the annual per person cost being $1,999.17. Whereas on the other hand, the annual per person indirect cost was $628.84 and the total cost amounts to $13.7 billion.

Burden status

The investigation for the economic burden of asthma in India and the USA surprisingly revealed the existence of latest data figures for the Indian population. This shows the increasing efforts on the part of researchers to establish a standard for comparison, concurrently monitoring the situation. Also, the difference in prevalence in urban and rural areas demands further research. This is because the literature suggests that people from rural areas have better health than urban dwellers.

The rising case of asthma may be influenced more by the barrier to healthcare services and awareness, rather than the interplay of genetic and environmental factors. With respect to per person costs, taking together the current costs of treatment for mild and severe asthma for India, the total direct per person cost amount to $340.630 (Rs 21710). The per-person cost is lower than USA estimates, which indicates lower costs in India. However, the central reasons behind lower costs need to be investigated in future. This will help improve public health policies and access to medicines for both developed and developing nations.

References

  • Cai, L. et al., 2014. The economic burden of smoking and secondhand smoke exposure in rural South-West China. Journal of Asthma, 51(5), pp.515–521.
  • Chronic Respiratory Disease Collaborators (2017) ‘Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015’, The Lancet Respiratory Medicine, 5(9), pp. 691–706.
  • Costafsilva, E. et al., 2015. Economic costs of asthma in Brazil: a one year real life study in outpatient setting. World Allergy Organization Journal, 8(S1), p.A4.
  • Ghoshal, A.G. et al., 2016. The burden of segregated respiratory diseases in India and the quality of care in these patients: Results from the Asia-Pacific burden of respiratory diseases study. Lung India: official organ of Indian Chest Society, 33(6), p.611.
  • Koshak, E.A., 2007. Classification of asthma according to revised 2006 GINA: Evolution from severity to control. Annals of thoracic medicine, 2(2), p.45.
  • Murthy, K. & Sastry, J.G., 2005. Economic burden of asthma. In NCMH Background Papers-—Burden of Disease in India. pp. 251–263.
  • Nunes, C., Pereira, A.M. & Morais-Almeida, M., 2017. Asthma costs and social impact. Asthma research and practice, 3(1), p.1.
  • Rappaport, H. & Bonthapally, V., 2012. The direct expenditures and indirect costs associated with treating asthma in the United States. J Allergy Ther, 3(2), p.1.
  • Sharma, S., 2017. World Asthma Day: India chokes, sales of medicines rise 43% in 4 years. Hindustan Times. Available at: http://www.hindustantimes.com/health/world-asthma-day-india-chokes-sales-of-medicines-rise-43-in-4-years/story-mt5V9Kdqv4yGF062ZOmC6I.html.
  • The Global Asthma Network, 2014. The global asthma report, Auckland.
Yashika Kapoor
 

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