The Projected Economic and Health Burden of Uncontrolled Asthma in the United States

A significant proportion of asthma patients remain inadequately controlled despite effective treatments available. The purpose of this study was to acknowledge the current economic and health burden of uncontrolled asthma in the United States as well as project future potentially preventable economic and health burden associated with uncontrolled asthma over the next 20 years.

This study included adults and adolescents aged ≥15 years in the United States. People with asthma were separated into controlled versus uncontrolled asthma using their Asthma Control Test (ACT) score.

To project burden over a 20-year timespan (2019–2038), researchers used a probabilistic model taking into account state-specific estimates of population growth, aging, asthma prevalence, and asthma control levels. Primary projections were made at a national level with secondary results done at a state level. Total direct costs, indirect costs and quality-adjusted life years (QALYs) due to uncontrolled asthma were included in the projections.

The total 20-year direct cost associated with uncontrolled asthma is estimated to be $300.6 billion (95% CI, $190.1 billion–411.1 billion) nationwide. When direct and indirect costs are combined, the total 20-year economic burden is projected to be $963.5 billion (95% CI, $664.1 billion–1262.9 billion). Quality-adjusted life years lost due to uncontrolled asthma will be 15.46 million (95% CI, 12.77 million–18.14 million). An additional analysis that separated uncontrolled asthma into not well controlled and very poorly controlled showed that the very poorly controlled group is responsible for 76% of direct costs, 83% of indirect costs, and 77% of QALYs lost. At the state level, the average 20-year per capita costs due to uncontrolled asthma ranged from $2209 to $6312.

The economic and health burden of asthma is significant and will continue to increase without intervention. A substantial proportion of this burden is preventable. The development and implementation of new asthma control strategies and improved adherence has the potential to greatly reduce costs and improve quality of life.

The public health impact of asthma in the United States is substantial. Despite a wide range of effective asthma treatments available, a large proportion of asthmatic individuals continue to remain inadequately controlled. People with uncontrolled asthma generally have more emergent care visits, hospitalizations, and missed work or school days, consistent with the direct and indirect costs noted in this study. Furthermore, those with uncontrolled asthma commonly have reduced quality of life. Previous studies examining the economic burden of asthma have generally looked at the overall cost of asthma, regardless of level of control, compared with not having asthma. This is important information when examining the comprehensive estimated economic burden of asthma. This study takes the next step by examining the current and projected cost within asthma groups (controlled versus uncontrolled), providing a more in-depth look to be considered by policymakers and asthma management programs. Having a thorough understanding of the burden of this disease can help fuel further searching for interventions and programs aimed at achieving asthma control.