Вы находитесь на странице: 1из 6

A CLOSER LOOK AT

Asthma results in approximately


5,000 deaths annually in the United
States and accounts for nearly half
a million hospitalizations, 1.6 million
emergency room visits, and over
10 million physician office visits.

A
JOINT PROJECT BETWEEN
T H E A S T H M A A N D A L L E R G Y F O U N DAT I O N O F A M E R I C A A N D
T H E N AT I O N A L P H A R M AC E U T I C A L C O U N C I L
A
sthma is a chronic, potentially National Asthma Education and Prevention Program
fatal disease caused by inflamed (NAEPP) of the National Institutes of Health released
airways that restrict airflow. guidelines as the first step toward attempting to reduce
7, 8
Disease characteristics are shortness of incidences of death and disability due to asthma. The
breath, wheezing, chest tightness and guidelines were distributed to more than 300,000
coughing.1 In 1996, asthma affected an practitioners to enhance physician understanding of
estimated 14.5 million people in the effective asthma management.
United States, an estimated 10.5 million
of whom were under the age of 45.2 In 1997, the guidelines were updated.1 They recommend
During the past two decades, the long-term control with daily use of inhalers for those with
number of asthma cases and asthma- moderate to severe asthma.1, 9 Although not new, inhalers
related deaths has increased, containing anti-inflammatory medicines have emerged as
particularly among economically the primary treatment for asthma.10 New drugs have
disadvantaged, urban, and minority recently been introduced that offer longer lasting effects
groups.3,4 Asthma is also increasing in for patients who require regular, frequent treatments, and
prevalence among children. The death offer oral dosage forms that are particularly useful to
rate due to asthma for children 19 children who may not be able to properly use inhalers.
years of age and younger increased by Although appropriate care and management does reduce
78 percent between 1980 and 1993.5 the use of asthma-related health care services, overall
There are about 470,000 compliance with national guidelines is low.11
hospitalizations and more than 5,000
deaths each year from asthma, and it is The NAEPP guidelines also emphasize the importance of
the third leading cause of preventable educating patients about the proper use of inhalers to
hospitalizations in the United States.6 manage asthma and recommend a written action plan for
Asthma is recognized as an important patients with moderate to severe persistent asthma or a
public health issue in the U.S. although history of severe asthma. However, studies from two major
it remains under diagnosed and under metropolitan areas of adults hospitalized with asthma
treated, possibly because signs and found that only 28 percent of the adult patients
symptoms vary widely from patient to patient as well as hospitalized had written action plans that explained how
within each patient over time.7 to manage their asthma.7

Managing asthma requires a long-term, multi-faceted Multiple efforts to prevent and appropriately treat asthma
approach, including patient education, frequent medical are being undertaken. The Center for Disease Control
follow-up, behavior changes, drug therapy, and avoidance (CDC) is working with state and local partners to
of asthma triggers such as irritants, viruses, and inhaled implement and evaluate comprehensive asthma
allergens to which the patient is sensitive. About one of prevention programs and is funding selected state and city
every five adults and children suffer from allergies, health agencies in their efforts to assess their asthma
including allergic asthma.5 programs. As these efforts become increasingly successful,
it is likely that pharmaceutical spending will continue to
Effective therapies are available to treat and manage increase. However, this increased use of asthma
asthma. Asthma therapies improve respiratory function, medications not only improves the quality of care for
thus reducing coughing, wheezing, and tightness in the asthma patients, but also reduces the use of other costly
chest, and improve the patient’s functional activity and medical resources.
quality of life. However, data shows an increase in
prevalence and complications of asthma despite available
effective therapies. In 1991, in response to this data, the
S
pending for asthma-related health care • The costs associated with asthma care increased 54
costs was estimated at more than $14.5 percent over a ten-year period.6
billion in the year 2000.12 Some other • In 1994 the estimated total asthma-related expenditure
startling statistics: in the U.S. was $7.8 billion. Of this, $5.1 billion was due
• Asthma results in approximately 5,000 to direct medical costs for treating asthma and $2.7
deaths annually in the United States and billion was in costs due to missed work and restricted
accounts for nearly half a million activities. Over half of the direct costs were from
hospitalizations, 1.6 million emergency hospitalizations.15
room visits, and over 10 million physician • Better treatment improves the quality of care for
office visits.13 asthmatics and reduces overall health care costs.16, 17
• An asthma patient experiences an average of 11.7 days of
restricted activity yearly and this restricted activity is the
single largest reason that children miss school.14
• Costs associated with time adults lost from work because
of their own asthma quadrupled over the last ten years.
Lost work time costs for caregivers of asthmatics and
housekeepers also increased by 88 percent.6

T
HE NATIONAL INSTITUTES OF HEALTH HAS
RECOGNIZED THE CRITICAL IMPACT OF APPROPRIATE
MEDICAL TREATMENT FOR ASTHMA AND HAS
ELEVATED ASTHMA TO A NATIONAL PUBLIC HEALTH ISSUE.

ASTHMA IN THE AFRICAN-AMERICAN COMMUNITY


• Asthma affects an estimated 14.5 million Americans. • Studies have identified several candidate genes for
Minority communities suffer disproportionately from the asthma, some of which may be more common in African-
chronic disease. American populations.
• Asthma is 26 percent more prevalent among African- • Investigators have identified a genetic change in an
American children than among Caucasian children. immune-signaling molecule involved in asthma and
• African-American children are three to four times more allergic responses that correlates with asthma severity.
likely than their Caucasian counterparts to be This change appears to be several-fold more common
hospitalized with asthma. among African-Americans than among Caucasians.
• African-Americans of all ages are three times as likely as • Asthma is only slightly more prevalent among African-
Caucasians to be hospitalized from asthma and three American children than among Caucasian children.
times as likely to die from the disease. However, African-American children with asthma
• More than 2 million African-Americans in the United experience more severe disability and have more
States suffer from asthma. frequent hospitalizations than do Caucasian children.
• Minority, inner-city families are more likely to be • Although African-Americans represent only 12 percent of
exposed to asthma risk factors, such as high levels of the U.S. population, they experience over 21 percent of
indoor allergens, including those borne by cockroaches, all asthma deaths.
tobacco smoke, and nitrogen dioxide (a respiratory
Source: Asthma and Allergy Foundation of America. (1998). Asthma in the
irritant produced by poorly vented stoves and heating African-American community fact sheet. Washington, D.C.: Author.
appliances).
• Minorities have difficulty obtaining sufficient follow-up
asthma treatment from a qualified health care provider
and gaining access to medications, inhalers or
nebulizers and other treatments that can help control
asthma.
A
STHMA PATIENTS AVERAGE 11.7 DAYS OF RESTRICTED ACTIVITY
YEARLY. THIS REPRESENTS THE SINGLE LARGEST REASON THAT
CHILDREN MISS SCHOOL. COSTS ASSOCIATED WITH MISSED
WORK AND RESTRICTED ACTIVITIES TOTALED $2.7 BILLION IN 1994.

METHODOLOGY Spending on pharmaceuticals was analyzed for asthma patients enrolled in managed care plans in
This study separately analyzed 1995 and 1998.
prescription drug spending
growth for two large national
claims databases, one
Price
representing managed care
plan enrollees and the other
representing those covered by
large employer-provided
health benefit plans. The study
FACTORS
defined and assessed several INFLUENCING
factors affecting the price per
day of therapy and the volume Volume
DRUG SPENDING
of therapy — the number of FOR ASTHMA
days of therapy received and
the number of patients
receiving drug therapy. The
analysis also examined the
effects of price and volume
changes for established drugs
on the market during the entire
Among health plan members, per person prescription contributed 27 percent of the
period of analysis and for new
asthma-related drug expenditures increased total increase in spending per member, due
drugs that were first marketed
by 94 percent. Volume factors (increased in part to a greater percentage of asthmatics
during this period.
numbers of people with asthma receiving treated for asthma-related conditions and
asthma and asthma-related prescriptions, asthma complications. The percentage of
and increased intensity and duration of drug asthmatics using asthma drugs increased
therapy) had a greater impact than did drug from 58 percent in 1995 to 76 percent
price factors. An increase in the proportion in 1998.
of plan members receiving an asthma-related

Factors Influencing Growth in Rx Expenditures: % Positive Impact % Negative Impact


Total Growth in Expenditures +94
Growth Due to Volume Factors +82
Changes in the Number of Prescriptions per Person for Established Drugs -19
Changes in the Number of Prescriptions per Person for New Entrants +63
Changes in Days of Therapy for Established Drugs +14
Changes in Days of Therapy for New Entrants -0.3
Patients per 1000 Health Plan Enrollees +25
Growth Due to Price Factors +12
Inflation -0.5
Changes in Mix of Established Drugs +17
Price of New Entrants -5
Source: Protocare Sciences managed care database
ASTHMA RESULTS IN 5,000 DEATHS ANNUALLY IN
THE UNITED STATES AND ACCOUNTS FOR NEARLY
HALF A MILLION HOSPITALIZATIONS, 1.6 MILLION
EMERGENCY ROOM VISITS AND OVER 10 MILLION
PHYSICIAN OFFICE VISITS.

ASTHMA-RELATED ER AND HOSPITAL USE


Emergency room visits fell by 31 visits per 1000 asthma patients and hospitalizations decreased
by 35 per 1000 asthma patients between 1995 and 1998. The cost savings from decreased
utilization of hospital resources per patient were $399. This offset the increase in drug
expenditures of $224.

500
424
No. per 1,000 Asthma Patients

400 393

300

200
16
163
128
100

0
ER Visits Hospitalizations

1995 1998

Source: Protocare Sciences managed care database

The change in volume of prescriptions for asthma was the The average number of prescriptions per patient per year
key driver in the overall growth in drug expenditures for increased from 13.0 to 17.1. Increases were observed for
asthma therapy. More patients received asthma medications used to treat asthma directly and for those
medications for longer periods of time in a manner used to treat complications of asthma and asthma-related
consistent with national guidelines for asthma care. diseases.

From 1995 to 1998, the percentage of asthmatic patients For medications used to treat asthma, increases in the rate
taking prescription drugs for their asthma and related of use were noted across all drug categories. The
conditions increased. In addition, the number of different percentage of patients using inhalers increased from 24
drugs prescribed and the length of therapy increased. A percent to 39 percent for one category of inhalers and from
decrease in acute care services was also demonstrated. 41 percent to 59 percent for another category of inhalers
Thus, increased use of medications according to the between 1995 and 1998.
standards of asthma care has contributed to favorable
outcomes. The “profile” of the asthma patient population changed
from 1995 to 1998. The average age of asthmatics increased
from 37.5 years to 43.3 years and the number of additional
medical conditions per patient increased from 8.8 to 9.6.
ABOUT THIS FOR MORE INFORMATION ABOUT ASTHMA,
PUBLICATION: PLEASE CONTACT:
“A Closer Look at Asthma” is a joint Asthma and Allergy Foundation of America (AAFA)
publication of the Asthma and Allergy www.aafa.org
Foundation of America and the National 1-800-7-ASTHMA
Pharmaceutical Council. American Academy of Allergy, Asthma and Immunology (AAAAI)
www.aaaai.org
The Asthma and Allergy Foundation of 1-800-822-2762
America (AAFA) is the premier patient
American College of Allergy, Asthma and Immunology (ACAAI)
organization dedicated to improving the
www.allergy.mcg.edu
quality of life for people with asthma 1-800-842-7777
and allergies, and their families through
education, advocacy and research. National Asthma Education and Prevention Program (NAEPP)
AAFA, a not-for-profit organization National Heart, Lung and Blood Institute
www.nhlbi.nih.gov/about/naepp
founded in 1953, provides practical
301-251-1222
information, community based services,
support and referrals through a national National Centers for Disease Control and Prevention (CDC)
network of chapters and educational www.cdc.gov
support groups. AAFA also raises funds 1-800-CDC-1311
for asthma care and research. National Institute of Allergy and Infectious Diseases (NIAID)
National Institutes of Health/
Since 1953, the National Pharmaceutical Office of Communications and Public Liaison
Council (NPC) has sponsored and www.niaid.nih.gov
conducted scientific, evidence-based 301-496-5717
analyses of the appropriate use of
pharmaceuticals and the clinical and 1
National Heart, Lung, and Blood Institute, National
9
McFadden E, Gilbert I, Asthma, New Engl J Med,
economic value of pharmaceutical Asthma Education and Prevention Program Expert 1992;327 (27):1928-37
innovation. NPC provides educational Panel Report II: guidelines for the diagnosis and
10

resources to a variety of health care management of asthma. Bethesda, MD: U.S. Georgitis JW. The 1997 asthma management
Department of Health and Human Services, 1997. guidelines and the therapeutic issues relating to the
stakeholders, including patients, NIH publication no. 97-4051 treatment of asthma. Chest. 1999;115;210-217
clinicians, payers and policy makers.
2 11
More than 20 research-based Centers for Disease Control and Prevention National Legorreta AP, Christian-Herman J, O’Connor RD,
pharmaceutical companies are members Center for Health Statistics. (2001). Fast Stats A-Z, Hasan MM, Evans R, Leung KW. Compliance with
of the NPC. [Online]. Available: http://www.cdc.gov/nchs/fastats/ national asthma management guidelines and
asthma.htm [8/2/01]. specialty care. Arch Intern Med. 1998;158:457-464
3 12
Brown CM, Anderson HA, Etzel RA. Asthma: The www.cdc.gov/nceh/programs/asthma/ataglance/
states’ challenge. Public Health Rep. 1997;112:198-205 asthmaag2.htm
4 13
Homer CJ. Asthma disease management. New Engl J National Center for Health Statistics. Monitoring
Med. 1997;227(20):1461-1463 Health Care in America. Spotlight on lung disease.
Quarterly Fact Sheet. December 1996
5
Centers for Disease Control and Prevention. (1998).
14
CDC’s Asthma Prevention Program, [Online]. Collins JG. Prevalence of selected chronic
Available: http://www.cdc.gov/nceh/asthma/factsheets/ conditions: United States, 1990-92. National Center
asthma.htm [07/11/01]. for Health Statistics. Vital Health Stat. 10(194).1997
6 15
Weiss, KB, Sullivan, SD, Lyttle, CS (2000). Trends in the Smith DH, Malone DC, Lawson KA, Okamoto LI,
cost of illness for asthma in the United States, 1985- Battista C, Saunders WB. A national estimate of the
1994. Journal of Allergy and Clinical Immunology, 106, economic costs of asthma. Am J Respir Crit Care Med.
For more information about NPC or for (3), 493-499. 1997;156:787-793
additional resources, please contact: 7 16
National Institutes of Health, National Heart, Lung, Nestor A, Calhoun AC, Dickson M, Kalik CA. Cross-
The National Pharmaceutical Council and Blood Institute. (1997). National Asthma Education sectional analysis of the relationship between
1894 Preston White Drive and Prevention Program, Practical Guide for the national guideline recommended asthma drug
Reston, VA 20191-5433 Diagnosis and Management of Asthma, 97-4053. therapy and emergency/hospital use within a
managed care population. Ann Allergy Asthma
8
National Heart, Lung, and Blood Institute. National Immunol. 1998;81:327-330
Phone: 703-620-6390 Asthma Education and Prevention Program Expert
Fax: 703-476-0904 Panel Report: Guidelines for the diagnosis and
17
Buchner DA, Butt LT, De Stefano A, Edgren B, Suarez A,
www.npcnow.org management of asthma. Bethesda, MD: U.S. Evans RM. Effects of an asthma management program on
Department of Health and Human Services, 1991. the asthmatic member: patient-centered results of a 2-
NIH publication no. 91-3042. year study in a managed care organization. Amer J
Managed Care. 1998;4(9):1288-1297

Вам также может понравиться