Poor asthma management unnecessarily drives up health care costs

Asthma burden of cost could be prevented by better adherence to medication guidelines.

Two Vancouver Coastal Health Research Institute scientists are uncovering surprising statistics about the cost of asthma in British Columbia. Dr. Mohsen Sadatsafavi of the Centre for Clinical Epidemiology and Evaluation, and his colleague Dr. J. Mark FitzGerald, director of the Centre for Heart and Lung Health, just completed a series of clinical trials and descriptive studies that all tell a similar story: asthma patients are costing BC a lot of money. And most of that spending could be avoided if patients were properly using available, affordable medications.

Dr. Sadatsafavi, assistant professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia, says there is no cure for asthma, but there are very effective medications that can control most cases. In fact, Dr. Sadatsafavi says 90 per cent of asthma patients have asthma that could be controlled. Yet, he found that only 25 to 30 per cent of patients have their disease under control.

“We are failing as a system. If you can achieve control you substantially reduce the costs and improve quality of life. But we have found that most patients in B.C. are left uncontrolled or only partially controlled. We have to do better.”

Dr. Sadatsafavi says the research results obviously raise a lot of questions as to why. “It might be a system failure that runs from policy makers to care providers to patients themselves. It appears the main culprit is low adherence to asthma treatment guidelines. We obviously have to figure out how to improve the way asthma is controlled out in the community.”

The study found that patients with uncontrolled asthma cost the system about $193 per person per week. Only $8 of that is in direct health care costs such as doctor visits for asthma symptoms. The rest is in lost productivity. Dr. Sadatsafavi says these results were surprising. And although most people would assume lost productivity is due to absenteeism, Dr. Sadatsafavi says the biggest costs are in on-the-job performance issues.

“Asthma patients with poor disease control use up all their sick days and end up working when they are only partly functional. Job performance is impaired by coughing, shortness of breath and fatigue.”  Dr. Sadatsafavi says there is a clear message for patients, caregivers and policy makers.

Surprising additional health care costs

When it comes to health care costs for all asthma patients, Dr. Sadatsafavi discovered more unexpected results. Using administrative health databases of B.C., his team found that each asthma patient costs the Province about $1000 more per year than the general population of the same age and sex. But, only 20 per cent of that cost is for actually treating asthma. The majority of health care spending on asthma patients is for unrelated conditions. For example, visits and testing for things like depression and anxiety, as well as endocrine and musculoskeletal issues were much higher than those of the general population.

The results left Dr. Sadatsafavi and his colleagues puzzled. “We can only theorize at this point why this is happening. Perhaps the more contact with the system, the more appointments and tests you may receive. Perhaps there are links to asthma. Clearly it’s a finding that needs more research. Importantly, the cost of treating asthma itself is going down, while the cost of those unrelated conditions is going up.”

Dr. Sadatsafavi’s findings have already spurred new research on better asthma management. A new clinical trial testing the use of text reminders for asthma patients just got funding based on his team’s work. 


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