title: Saving in medical costs by achieving guideline-based asthma symptom control: a population-based study.
abstract: BACKGROUND
  Asthma control is increasingly used as an outcome measure in asthma trials. Economic evaluations of asthma interventions require converting the impact of interventions on control to impact on resource use. The purpose of this study was to estimate the savings in direct costs by achieving asthma symptom control as defined in the Global Initiative for Asthma (GINA) 2014 management strategy.
  
  
  METHODS
  Adolescents and adults with asthma were recruited through random digit dialing. Asthma control per GINA and the use of healthcare resources were assessed at baseline and three-monthly visits up to 1 year. We used regression models to associate costs, measured in 2012 Canadian dollars ($), with symptom control, adjusting for potential confounding variables.
  
  
  RESULTS
  The final sample included 517 individuals (average age 48.9, 65.8% female) with mostly mild-moderate asthma contributing 2033 follow-up visits. In 598 (29.4%), 809 (39.8%), and 626 (30.8%) of visits, asthma was symptomatically controlled, partially controlled, or uncontrolled, respectively. The average 3-month costs of asthma were $134.5. Of these, 20.5% were attributable to inpatient care, 47.8% to outpatient care, and 31.5% to medication. Compared to controlled asthma, partially controlled asthma was associated with a nonsignificant increase of $9.5 (95% CI -$13.6 - $32.6) in adjusted 3-month costs and uncontrolled asthma with a statistically significant increase of $81.7 (95% CI $48.5 - $114.9).
  
  
  CONCLUSIONS
  A substantial fraction of this population-based sample of largely mild-moderate asthmatics was symptomatically uncontrolled. Achieving symptom control was associated with a reduction in direct costs. The adjusted values from this study can be used to inform cost-effectiveness analyses of asthma treatments.
authors.affiliation: Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sadatsafavi
authors.affiliation: Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.affiliation: Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Tavakoli
authors.affiliation: Kelowna Allergy & Respirology Research, Kelowna, BC, Canada.
authors.forename: J D
authors.initials: JD
authors.lastname: Rolf
authors.affiliation: Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Rousseau
authors.affiliation: Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: FitzGerald
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy; D001955:British Columbia; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D012307:Risk Factors
keywords: asthma; cost-effectiveness; costs; outcomes