title: Economic burden of impairment in children with severe or difficult-to-treat asthma.
abstract: BACKGROUND
  The cost associated with asthma impairment in children with severe asthma has not been determined.
  
  
  OBJECTIVE
  To assess the asthma cost burden in children with severe or difficult-to-treat asthma based on asthma impairment.
  
  
  METHODS
  Children aged 6 to 12 years in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with available data at baseline (n = 628), month 12 (n = 385), and month 24 (n = 280) corresponding to the National Heart, Lung, and Blood Institute asthma guidelines' impairment domain were included. Children were categorized as either very poorly controlled (VPC), not well controlled (NWC), or well controlled (WC) and assessed cross-sectionally and longitudinally. Mean total asthma costs based on direct (medication usage, unscheduled office visits, emergency department visits, hospitalizations) and indirect (school/work days lost) asthma costs were assessed.
  
  
  RESULTS
  Mean annual total asthma costs were more than twice as high in the VPC group compared with NWC and WC groups (baseline: $7,846, $3,526, $3,766.44, respectively; month 12: $7,326, $2,959, $2,043, respectively; month 24: $8,879, $3,308, $1,861, respectively (all P < .001). Indirect costs accounted for approximately half the total asthma costs for VPC asthma patients at each time point. Significantly lower costs were observed for patients whose impairment status improved or temporarily improved from VPC after baseline.
  
  
  CONCLUSIONS
  The economic burden of severe or difficult-to-treat asthma in children is associated with VPC asthma and improvement in asthma control and is associated with reducing cost. Further attention to patients with poorly controlled asthma, through better management strategies or more effective medications, may significantly reduce this burden of illness.
authors.affiliation: National Jewish Health, Denver, Colorado, USA.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Tmirah
authors.initials: T
authors.lastname: Haselkorn
authors.forename: David R
authors.initials: DR
authors.lastname: Mink
authors.forename: Tripthi V
authors.initials: TV
authors.lastname: Kamath
authors.forename: James E
authors.initials: JE
authors.lastname: Fish
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Chipps
mesh_terms: D001249:Asthma / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires