Asthma economics: focusing on therapies that improve costly outcomes

In 1998, the economic burden of asthma was estimated to be 12.7 billion dollars. Subsequent research has focused on identifying important outcomes that reflect high resource utilization and finding therapies that improve these outcomes and decrease cost. Recent developments include an update to the National Heart, Lung, and Blood Institute (NHLBI) guidelines, new treatment strategies using combination therapy, and the development of a monoclonal antibody therapy for asthma.

Two important costly outcomes are asthma-related hospitalizations and emergency department visits. Asthma-related hospitalizations started to decline in the 1990s, primarily in white Americans, but not in young African Americans. Many hospitalizations and emergency department visits are preventable, and costs were lowered by shifting management to the ambulatory care setting. Increased asthma severity and suboptimal compliance with NHLBI asthma care guidelines can contribute to the persistence of symptoms, which triggers behaviors that increase resource utilization.A recent economic analysis was one of the first well-controlled clinical trials to show that inhaled corticosteroids provide clinical benefit at modest costs. Combination therapy, particularly that containing an inhaled corticosteroid and long-acting bronchodilator in a single inhaler, potentially can reduce overall costs by improving compliance with inhaled corticosteroids. Nonpharmacologic therapies also have been shown to be cost-effective. However, a significant number of patients with asthma continue to have symptoms even while on recommended controller therapy. Omalizumab, a monoclonal antibody treatment that binds IgE, was released in the summer of 2003.

Many costly asthma-related hospitalizations and emergency department visits are preventable, and chronic disease care can be shifted to the ambulatory setting. Increased asthma severity and noncompliance with NHLBI guidelines are associated with increased resource utilization. Combination therapies can assist in improving patient compliance, and omalizumab potentially offers a novel but expensive way to decrease symptoms and resource utilization.