Factors affecting UK primary-care costs of managing patients with asthma over 5 years.
OBJECTIVE
To determine the effect of age, disease severity and compliance on the annual primary-care cost of managing patients with asthma initially on British Thoracic Society British Guidelines on Asthma Management (BGAM) treatment steps 2/3 over 5 years.


METHODS
A modelling study performed from the perspective of the UK's National Health Service (NHS). STUDY PARTICIPANTS AND INTERVENTIONS: A data set was created comprising 4519 patients with asthma in the DIN-link database who were prescribed twice-daily inhaled corticosteroids and who were on steps 2/3 between 1 January and 31 December 1993. These patients were followed over 5 years.


METHODS
Asthma-related primary-care resource utilisation data obtained from the DIN-link database were stratified by patients' age, compliance and BGAM treatment step. Unit costs at 1999-2000 prices were applied to the resource use estimates to determine the mean annual cost per patient.


RESULTS
High compliance with inhaled corticosteroids was not associated with a reduction in use of other primary-care resources, although the ratio of the number of prescriptions for inhaled corticosteroids to that for short-acting beta(2)-agonists increased, suggesting that patients' asthma was better controlled. Overall, the primary-care cost of managing a patient starting on steps 2/3 was found to be most strongly influenced by whether that patient moved onto steps 4/5 or continued to be managed on the same treatment step. If a patient continued to be managed at steps 2/3, costs were influenced in descending order of impact by compliance, previous BGAM step and the patient's age.


CONCLUSIONS
Better compliance with inhaled corticosteroids is likely to lead to better asthma control and fewer asthma attacks. Notwithstanding this, increasing compliance is likely to increase primary-care costs. Consequently increasing healthcare expenditure may be the inevitable consequence of improving asthma control.
Dasgupta
Roben
R
CATALYST Health Economics Consultants, Northwood, Middlesex, UK.
Guest
Julian F
JF
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000191:economics*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000191:economics*; D013256:Steroids; D006113:United Kingdom
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids