The discussions on allergic disorders till now emphasized on the prevalence and severity, besides highlighting the significant treatment options. Henceforth, it is essential to discuss the economics associated with the different treatment options. This demands the exploration of the cost of illness also known as the burden of disease.
Cost of illness (COI)
The cost of illness (COI) for any disease can range from the incidence of a disease to its impact on longevity and quality of life. It also includes the direct costs and indirect costs, which are essential for understanding the economic consequences. The analysis of economic impact allows for a complete analysis of the burden of disease on the society and economy. The traditional COI studies include stratification of the costs into direct, indirect, and intangible costs. The direct costs are borne by the health system, family, patient and the society, involving both the healthcare and non-healthcare costs. The indirect costs incur the productivity losses due to the adverse impact of the disease. The intangible costs refer to the reduction in Quality of Life (QOL) due to the pains and sufferings of the disease.
Thus, the knowledge of the COI for any disease is important as it serves the broader perspectives of society and government. The prior knowledge can help in counteracting the probable health shocks due to disease, which can have a negative impact on education and income. It also helps the concerned agencies to formulate effective health care policies, interventions with the simultaneous management of budgetary concerns. Consequently, COI at the grassroots level impacts the patients and their families. Therefore, it is crucial for governments to manage the burden efficaciously (Jo, 2014).
Global disease burden of allergic disorders
Allergic disorders continue to expand globally, affecting 30-40% of the population worldwide. Environmental deterioration is ultimately causing a rise in the prevalence of allergic diseases. The climatic changes with increasing ambient temperatures also tend to bring changes in the prevalence of prominent sources of allergens such as pollens, insect stings and mold prevalence (World Allergy Organization, 2011).
As emphasized in the previous article, Allergic Rhinitis, Atopic Dermatitis, and Asthma are the most prevalent allergies amongst the five case nations. These allergies affect the rich strata of the population first, spreading to the middle class and ultimately to the poorest in countries undergoing epidemiological transition. The image below shows the association of socioeconomic status of individuals with the prevalence of allergic diseases (Matricardi, 2014).
This phenomenon occurs as the rich face low antigenic burden that is due to lifestyle conditions. The reduced antigenic burden results in low stimulation of the immune system and dysregulation of allergic immune responses (Matricardi, 2014). The developed nations of the west due to the urban lifestyle face limited exposure to infectious agents. The sanitary living conditions pave the way to high risks of developing allergies. The low microbial burden results in insufficient stimulation of Th1 response. This results in the failure of dampening of Th2 cells resulting in overactive Th2 responses later on in life (Graham-Rowe, 2011).
The Type 1 T helper (Th1) cells produce interferon gamma, tumor necrosis factor and interleukins which are responsible for cell-mediated immune responses towards the pathogens. The Type 2 Th (Th2) cells produce series of interleukins which produce a chain of responses responsible for phagocyte independent protective responses.
Allergy epidemic around the globe
Of all the allergic disorders Asthma, Atopic Dermatitis and Allergic Rhinitis together constitute the allergy epidemic (Matricardi, 2014).The images below show the high prevalence of allergy epidemic amongst the developed nations. Atopic Dermatitis is seen to affect up to 30% children, whereas only 10% adults (Connelly, 2017). Therefore, the map for the same shows the prevalence of pediatric atopic dermatitis around the world.
Treatment costs of the allergy epidemic
The rising trends in allergy prevalence demand an exploration into the COI of allergies. Allergic disorders such as Asthma, Atopic Dermatitis and others pose a substantial burden on society as these conditions prove to be chronic. These incur lifetime healthcare and non-healthcare costs for disease management. Hence, it is important to perform an analysis of the economic burden of allergies on society. The analysis will require looking at the burden scenario with respect to the direct, indirect and intangible costs.
Economic burden of allergy in different countries
The following sections discuss the COI with respect to 6 case nations ( USA, UK, Japan, Africa, Australia, and India). The analysis for these case nations presents a holistic comparison of the cost of illness in developed and developing nations. This will allow the reader to assess the differences in the degree of costs and impact on the quality of life.
The table below shows the COI for allergy epidemic in the USA. Atopic Dermatitis is seen to contribute highest to the economic burden in terms of direct and indirect costs. However, the total annual expenditure and prevalence rates are highest for Allergic Rhinitis. The data for the assessment of the quality of life for the USA is scarce.
Total annual costs
|Rhinitis||$3.7 (2.3–4.7) billion||$2257.33 million||$335.46 million|
|Atopic dermatitis||Commercial: US$10,461 Medicare: US$16,914 Medi-Cal: US$19,462||$1.009 billion||$37.7 billion|
|Asthma||$1035.18 million||$879.7 million||$155.48 million|
Table 1: COI of prevalent allergies in USA
The table below shows the COI for allergy epidemic in the UK. The annual costs of Asthma are highest in the UK. The data for comparison of the economic burden and quality of life for allergy epidemic for the UK is scarce.
Total annual costs
|Rhinitis||NA||NA||£1.25 billion/year (absenteeism from work)|
|Atopic dermatitis||£27.6 million||$609 per patient annually|
|Asthma||£1.1 billion||£1 billion – England and wales £130 million – Scotland||NA|
Table 2: COI of prevalent allergies in the UK
The latest cost estimation study dates back to 1994, which shows an expenditure of $1.15 billion for Allergic Rhinitis. The QOL studies for estimating the intangible costs indicate a reduction in score for all the allergies. For Atopic Dermatitis, the patients who develop pruritus lesions on neck reported highest reductions in QOL scores (Fukuroku et al 2002). The literature indicating the direct and indirect costs of treating allergic diseases in Japan is lacking.
The Australian data especially concentrates on Asthma, with the total costs of treating the allergy reported to be $808.0 million in 2007. Also, the total COI for non-Asthma allergies amounted to $349.3 million in 2007. The multiple studies on quality of life indeed indicate the negative impact of illness on life. It is not only the patient but the family also gets affected.
The minimal number of studies which attempt to investigate the COI of allergies in India present the results for small sample sizes. An Indian study reported the total cost of Atopic Dermatitis as Rs. 6235.00 ± 3514.00 for a sample of 40 children (Handa, Jain, & Narang, 2015). Another study on QOL for 40 Indian patients suffering from Rhinitis reported females to have lower QOL standards as compared to males (Sharma et al., 2015). The extrapolation of information from such small sample size to such large population is not feasible.
Lack of recognition of allergic disorders as a serious disease
Allergic disorders are a group of chronic illness, which severely impacts the lives of the affected individual. These are not only a psychological and economic burden for the concerned person but also for the society and country at large. The management of allergies incurs significant economic burden and reduces the productivity levels. The COI for allergies was well accounted for in USA and UK but lacked in assessing the QOL. However, the other developed case nations (Japan and Australia) lacked in monitoring the economic burden of allergies. The developing economies (Africa and India) on the other hand presented no official government accounts for the economic burden of allergies. Apart from the government accounts, the published studies report data for small sample sizes.
A cumulative assessment of direct and indirect costs for the three most common allergic disorders also showed insufficiency. The present state of affairs reflects the lack of recognition of allergies as a serious disease. The government of developing economies of Africa and India need to recognize the importance of maintaining official data on economic burden. Such an assessment is also crucial for framing relevant healthcare policies and educate people for better management of allergic disorders. Also, an assessment of the intangible cost is also necessary to keep a check on the QOL of citizens. The lower standards of QOL of the people due to allergic disorders cause impairment of physical, mental and social well being. It also adversely affects the nation’s rate of development, as citizens with reduced productivity cannot effectively engage in social and economic activities.
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