Risk factors and costs associated with an asthma attack
G Hoskinsa, C McCowana, R G Nevillea, G E Thomasb, B Smitha, S Silvermanc
a Tayside Centre for
General Practice, University of Dundee, Kirsty Semple Way, Dundee DD2
4AD, UK, b Department of Mathematics, University of
Dundee, Dundee DD1 4HN, UK, c Astra Zeneca plc, Alderley House, Alderley Park,
Macclesfield, Cheshire SK10 4TF, UK
Correspondence to: Mrs G Hoskins, Tayside Centre for General Practice, University of Dundee, Dundee DD2 4AD, UK
Received 11 March 1999; Returned to authors 28 May 1999; Revised version received 13 September 1999; Accepted for publication 27 September 1999
BACKGROUND
A study was
undertaken to identify asthma patients at risk of an attack and to
assess the economic impact of treatment strategies.
METHODSA
retrospective cohort analysis of a representative data set of 12 203
patients with asthma in the UK over a one year period was performed.
Logistic multiple regression was used to model the probability of an
attack occurring using a set of categorised predictor factors. Health
service costs were calculated by applying published average unit costs
to the patient resource data. The main outcome measures were attack
incidence, health service resource use, drug treatment, and cost
estimates for most aspects of asthma related health care.
RESULTSChildren under
five years of age accounted for 597 patients (5%), 3362 (28%) were
aged 5-15 years, 4315 (35%) 16-44, 3446 (28%) 45-74, and 483 (4%)
were aged over 74 years. A total of 9016 patients (74%) were on some
form of prophylactic asthma medication; 2653 (22%) experienced an
attack in the year data collection occurred. Overall health care
expenditure was estimated at £2.04 million. The average cost per
patient who had an attack was £381 compared with £108 for those who
did not, an increase of more than 3.5 times. In those aged under five
and those over 75 years of age there were no significant markers to
identify risk, but both groups were small in size. The level of
treatment step in the British Thoracic Society (BTS) asthma guidelines
was a statistically significant factor for all other age groups. Night
time symptoms were significant in the 5-15, 16-44 and 45-74 age
groups, exercise induced symptoms were only significant for the 5-15
age group, and poor inhaler technique in the 16-44 age group.
CONCLUSIONSPatients
at any treatment step of the BTS asthma guidelines are at risk of an
asthma attack, the risk increasing as the treatment step increases.
Poorly controlled asthma may have a considerable impact on health care
costs. Appropriate targeting of preventive measures could therefore
reduce overall health care costs and the growing pressures on hospital
services associated with asthma management.
Keywords: asthma; BTS guidelines; treatment; cost
© 2000 by Thorax
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