Trends in Cost, Health Status and Functional Outcomes Among Adult and Pediatric Patients with Asthma: 2000-2009
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Background: Asthma, a chronic inflammatory disease of the respiratory tract, has a high prevalence and substantial deleterious effects on health care costs in the U.S. Very few studies have examined recent trends in medical expenditures, health status, and functional outcomes among patients with asthma. Objectives: To examine the level and changes in medical costs, health status and functional outcomes in adults and pediatrics with asthma and to provide nationally representative estimates of medical costs from 2000 through 2009. Methods: Data from the 2000-2009 Medical Expenditure Panel Survey (MEPS) were used. Patients with asthma were identified by self-reported lifetime asthma diagnosis or medical condition based on International Classification of Disease, Ninth Revision, Clinical Modification. We studied the trends among three age groups: adults age 18 and above, adolescents ages 6-17, and children ages 0-5. Generalized linear models were used to examine the change in health care costs (adjusted for medical price inflation) and functional outcomes (number of work days lost (WDL) in adults and number of school days lost (SDL) in adolescents), while ordinary least square regression (OLS) was used for health status outcome (Physical Component Summary (PCS) and Mental Component Summary (MCS) from SF-12v2 Health Survey), adjusting for clinical and demographic characteristics, socioeconomic status and comorbidity. Two part models were used to estimate the medical costs of asthma. Results: Among adults, the mean PCS decreased 0.09 units annually (p<.01) and the trends of mean MCS was not significant. There was no significant change in the number of WDLs and marginal decrease in SDLs with 1.8% annually (p=.06). The trends of medical costs in adults and children with asthma were not significant. However the medical expenditures increased 2.5% annually during the ten year period in adolescents (p=.049). For the most recent year available (2009), the total incremental health care costs of asthma in the United States were $53 billion, $7 billion and $3 billion in adults, adolescents and children, respectively. Conclusion: This study finds that over a 10-year period, medical costs in asthma patients have increased or remained similar in all age groups, while outcomes have not improved. These data reflect a period of time in the US where increasing attention has been paid to asthma disease management. The lack of improvement in outcomes suggests that approaches to asthma management in the U.S. should be reexamined and modified.
- Health services