Socioeconomic factors and risk for hospitalisation due to asthma in children in the municipalities of Mato Grosso State, Brazil / Fatores socioeconômicos e risco para a hospitalização por asmaem crianças em municípios de Mato Grosso, Brasil

Abstract This ecological study used data accumulated between 2001 and 2012 hospital admissions of children under five years of age with asthma in 141 municipalities in the Mato Grosso. Hospital data were extracted from the SIH/SUS system, and hospitalisation rates were estimated using the Bayesian inference method. SaTScan software was used for the calculation of the relative risk (RR). Differences in socioeconomic characteristics among municipalities with high and low hospitalization rates were evaluated by nonparametric Wilcoxon-Mann-Whitney test. This test indicates that municipalities with better socioeconomic characteristics have lower hospitalization rates. The analysis of the linear models in the two study periods indicated that the decreasing trend in the number of admissions was 3-fold higher in the 2005-2012 period compared with the 2001-2004 period. In addition, a decrease of 76% in the hospitalisation incidence rate was observed during the 12-year study period; this decrease was more evident from 2005 onward. The municipalities identified as having increased risk of hospitalisation of children with asthma were located in areas subjected to intense burning practices and with low municipal development indices.

Resumo Trata-se de um estudo ecológico com dados de hospitalizações de crianças menores de cinco anos de idade com asma, entre 2001 a 2012, nos 141 municípios do estado de Mato Grosso, com o objetivo de analisar a distribuição e o risco de hospitalização por esse problema em crianças no estado de Mato Grosso. Os dados hospitalares foram extraídos do SIH/SUS e as taxas de internação foram estimadas por meio do método de inferência bayesiana. Para realização do cálculo do risco relativo (RR) utilizou-se a técnica de varredura espacial, com o software SatScan. Diferenças de características socioeconômicas entre municípios com altas e com baixas taxas de hospitalização foram avaliadas pelo teste não paramétrico de Wilcoxon-Mann-Whitney. Avaliou-se que municípios com características socioeconômicas melhores têm menores taxas de hospitalização. Além disso, foi verificada uma redução de 76% ao longo de doze anos, mais evidenciada a partir de 2005. Os municípios identificados com maior risco de hospitalização de crianças por asma localizam-se em áreas com intensa atividade de queimadas e baixo índice de desenvolvimento municipal.

Custo-efetividade da telemedicina no acompanhamento de asmáticos: revisão sistemática / Costo-beneficio de la telemedicina en el acompañamiento de asmáticos: revisión sistemática / Cost-effectiveness of telemedicine in the follow-up of asthmatics: a systematic review

OBJETIVO: revisar sistematicamente a literatura sobre o custo-efetividade da telemedicina no acompanhamento de asmáticos. MÉTODO: Revisão sistemática nas bases de dados PUBMED/MEDLINE, LILACS e Central Cochrane. Consideraram-se artigos publicados em inglês, português ou espanhol, no período de 2005 a 2018, de acordo com as diretrizes PRISMA. RESULTADOS: Foram identificados 1363 artigos, dos quais 59 foram lidos na íntegra. Apenas cinco atenderam os critérios de elegibilidade, todos foram realizados em países europeus e somaram 2497 participantes. As intervenções foram realizadas por enfermeiras (4 de 5 estudos), permanecendo de 16 semanas a 12 meses. Custos com telemedicina foram semelhantes ou ligeiramente menores em comparação aos tratamentos usuais. A telemedicina apresentou efeito benéfico no controle da asma (1 de 5 estudos), qualidade de vida (3 de 5 estudos) e hospitalizações (1 de 5 estudos). CONCLUSÃO: A telemedicina reduz ligeiramente os custos com manejo da asma e pode ter impacto em indicadores de morbidade.

OBJETIVO: revisar sistemáticamente la literatura sobre el costo-beneficio de la telemedicina en el acompañamiento de asmáticos. MÉTODO: Revisión sistemática en las bases de datos PUBMED/MEDLINE, LILACS y Central Cochrane. Se consideraron los artículos publicados en inglés, portugués o español, en el período de 2005 a 2018, de acuerdo con las directrices PRISMA. RESULTADOS: Fueron identificados 1363 artículos, y de ellos, 59 fueron leídos en la íntegra. Solamente cinco atendieron a los criterios de elegibilidad, todos fueron realizados en países europeos y sumaron 2497 participantes. Las intervenciones fueron realizadas por enfermeras (4 de 5 estudios), permaneciendo de 16 semanas a 12 meses. Los costos con telemedicina fueron semejantes o ligeramente menores comparados a los tratamientos usuales. La telemedicina presentó efecto benéfico en el control del asma (1 de 5 estudios), calidad de vida (3 de 5 estudios) y hospitalizaciones (1 de 5 estudios). CONCLUSIÓN: La telemedicina reduce ligeramente los costos con el asma y puede tener impacto en indicadores de morbididad.

AIM: systematic review of the literature on the cost-effectiveness of telemedicine in the follow-up of asthmatics. METHOD: Systematic review of the PUBMED / MEDLINE, LILACS and Cochrane Central databases. Articles published in English, Portuguese or Spanish were considered in the period from 2005 to 2018 according to the PRISMA guidelines. RESULTS: A total of 1363 articles were identified, of which 59 were read in their entirety. Only five met the eligibility criteria, and all were made in European countries and totaled 2,497 participants. The interventions were performed by nurses (4 of 5 studies), remaining from 16 weeks to 12 months. Telemedicine costs were similar or slightly lower compared to usual treatments. Telemedicine had a beneficial effect on asthma control (1 of 5 studies), quality of life (3 out of 5 studies) and hospitalizations (1 of 5 studies). CONCLUSION: Telemedicine slightly reduces costs with asthma management and may have an impact on morbidity indicators

Estimated cost of asthma in outpatient treatment: a real-world study / Estimativa de custo da asma em tratamento ambulatorial: estudo com dados de mundo real

ABSTRACT OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

RESUMO OBJETIVO Estimar o custo do diagnóstico e tratamento da asma. MÉTODOS Foi utilizada a perspectiva da sociedade. Foram incluídos por 12 meses em 2011-2012, sequencialmente, 117 indivíduos maiores de cinco anos de idade, em tratamento por asma nos Serviços de Pneumologia e Alergia-Imunologia da Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro. Todos realizaram duas entrevistas com seis meses de intervalo para coleta de dados, cobrindo 12 meses. As unidades de custos foram identificadas e valoradas de acordo com métodos definidos. Foi feita análise de sensibilidade e foram aplicados métodos estatísticos com nível de significância de 5% para comparações de custos entre subgrupos. RESULTADOS Cento e oito pacientes completaram o estudo, 73,8% eram mulheres. Mediana de idade foi de 49,5 anos. Rinite esteve presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade. A renda familiar média foi de R$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença.

The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system / Impacto da asma no Brasil: análise longitudinal de dados extraídos de um banco de dados governamental brasileiro

ABSTRACT Objective: To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013. Methods: This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed. Results: In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million. Conclusions: Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries.

RESUMO Objetivo: Apresentar dados longitudinais oficiais sobre o impacto da asma no Brasil entre 2008 e 2013. Métodos: Estudo descritivo de dados extraídos de um banco de dados do governo brasileiro entre 2008 e 2013, no qual foram analisados as hospitalizações e óbitos por asma, bem como o custo das hospitalizações. Foi também realizada uma subanálise geográfica. Resultados: Em 2013, 2.047 pessoas morreram de asma no Brasil (5 óbitos/dia), com mais de 120.000 hospitalizações por asma. Durante o período de estudo, o número absoluto de óbitos e hospitalizações por asma diminuiu 10% e 36%, respectivamente. No entanto, a taxa de mortalidade hospitalar aumentou aproximadamente 25%. A subanálise geográfica mostrou que as regiões Norte/Nordeste e Sudeste apresentaram as maiores taxas de hospitalização e mortalidade hospitalar por asma, respectivamente. A análise dos estados representativos de cada região mostrou discrepâncias entre as hospitalizações por asma e as taxas de mortalidade hospitalar por asma. Durante o período de estudo, as hospitalizações por asma custaram US$ 170 milhões ao sistema público de saúde. Conclusões: Embora os óbitos e hospitalizações por asma no Brasil estejam diminuindo desde 2009, os números absolutos ainda são altos, com elevados custos diretos e indiretos para a sociedade, o que mostra a relevância do impacto da asma em países de renda média.

Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States

PURPOSE: To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS: This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS: Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. CONCLUSION: Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.

Workers' Compensation for Occupational Respiratory Diseases

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

Prevalência e duração dos benefícios auxílio-doença decorrentes de asma no Brasil em 2008 / Prevalence and duration of social security benefits allowed to workers with asthma in Brazil in 2008

OBJETIVO: Determinar a prevalência e a duração dos benefícios auxílio-doença (BAD) decorrentes de asma concedidos pelo Instituto Nacional de Seguro Social aos empregados no Brasil em 2008. MÉTODOS: Estudo descritivo e retrospectivo a partir do banco de dados do Sistema Único de Benefícios sobre os BAD decorrentes de asma concedidos em 2008. A população de referência consistiu da média mensal dos empregados registrados no Cadastro Nacional de Informações Sociais em 2008. Foram estudadas as variáveis ramo de atividade econômica, sexo, idade, tipo e duração dos BAD. A relação trabalho-doença foi avaliada por razão de prevalência (RP) entre BAD acidentários e previdenciários. RESULTADOS: Em 2008, foram concedidos 2.483 BAD por asma, com prevalência de 7,5 BAD por 100.000 empregados. A prevalência foi maior em mulheres que em homens (RP = 2,1 entre os sexos). Empregados com > 40 anos tinham 2,5 vezes maior probabilidade de receber BAD por asma do que aqueles com < 40 anos. Os ramos esgoto e atividades relacionadas, fabricação de produtos de madeira e fabricação de móveis tiveram as maiores prevalências (78,8; 22,4; e 22,2 BAD/100.000 empregados, respectivamente). A mediana (intervalo interquartílico) da duração dos BAD foi de 49 (28-87) dias. CONCLUSÕES: A asma é uma importante causa de afastamento do trabalho com forte componente ocupacional na sua etiologia, resultando em grande impacto para empregadores, empregados e previdência social. Ser mulher, ter > 40 anos e trabalhar nos segmentos de esgoto, fabricação de produtos de madeira e de fabricação de móveis aumentam a probabilidade de afastamento do trabalho por asma.

OBJECTIVE: To determine the prevalence and duration of social security benefits (SSBs) claims to registered workers with asthma in Brazil by the Brazilian National Institute of Social Security in 2008. METHODS: This was a retrospective, descriptive study, based on information obtained from the Brazilian Unified Benefit System database, on the number of SSB claims granted to registered workers with asthma in 2008. The reference population was the monthly mean number of workers registered in the Brazilian Social Registry Database in 2008. The variables studied were type of economic activity, gender, age, and type/duration of the SSB claim. The relationship between work and asthma was evaluated by the prevalence ratio (PR) between work-related and non-work-related SSB claims for asthma. RESULTS: In 2008, 2,483 SSB claims were granted for asthma, with a prevalence of 7.5 allowances per 100,000 registered workers. The prevalence was higher among females than among males (PR = 2.1 between the sexes). Workers > 40 years of age were 2.5 times more likely to be granted an SSB claim for asthma than were younger workers. The prevalence was highest among workers engaged in the following types of economic activity: sewage, wood and wood product manufacturing, and furniture manufacturing (78.8, 22.4, and 22.2 claims/100,000 registered workers, respectively). The median (interquartile range) duration of SSB claims for asthma was 49 (28-87) days. CONCLUSIONS: Asthma is a major cause of sick leave, and its etiology has a strong occupational component. This has a major impact on employers, employees, and the social security system. Being female, being > 40 years of age, and working in the areas of urban sanitation/sewage, wood and wood product manufacturing, and furniture manufacturing increase the chance of sick leave due to asthma.

Epidemiology of Asthma / Epidemiologia da asma

Quando comparadas às principais causas globais de doença e morte, as doenças respiratórias recebem menos atenção e financiamento. Particularmente na asma, todos os indicadores epidemiológicos sinalizam um grande e crescente problema de saúde pública. Estima-se que 300 milhões de pessoas em todo o mundo sejam asmáticas e que 180.000 mortes anuais sejam causadas por asma. No Brasil, o estudo ISAAC identificou áreas com altas prevalências de asma, similares às do norte da Europa e da Oceania. Enquanto um estudo de mortalidade concluiu que a asma é responsável por mais de 2.000 mortes anuais no Brasil, ou seja, cerca de 6 por dia, com uma grande variação regional, outro estudo sobre morbidade quantificou cerca de mil hospitalizações diárias, representando um custo de R$100 milhões anuais para o Sistema Único de Saúde. Pode-se concluir que, face às mudanças demográficas nas populações, no estilo de vida e à epidemia tabágica, a asma continuará sendo um peso crescente em vários países do mundo, incluindo o Brasil.

Impacto del asma en escolares de dos centros de salud primaria / Impact of asthma among primary attention children

Background: Asthma is one of the chronic diseases that generate an impact on quality of life and major health care expenses. Aim: To evaluate the impact of asthma on primary attention expenses, the health related quality of life (HRQOL) and the sanitary resources use. Material and Methods: Follow up of a cohort of 56 asthmatic children aged 6 to 14 years (56 percent women), during 12 months. The severity and the impact of the disease on HRQOL was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) respectively Costs were derived from the number of medical attentions, hospital admissions, medication requirements, school absenteeism among patients and work absenteeism among caregivers. Results: Patients required twice the number of medical attentions than the general population. Fourteen percent of children had severe asthma. Compared with subjects without severe asthma, the latter required more attentions (3.8 and 9.7 attentions per year respectively, p< 0.01), had a lower PAQLQ score (4.1 ±0.11 and 5.2 ± 1 respectively, p< 0.05) and a higher school absenteeism (10 and 27 days per year respectively, p < 0.01). Medication use was not different between patients with and without severe asthma. They early cost per patient was $ 106,550 (Chilean pesos). Conclusions: Asthma has a great impact on HRQOL and the use of primary attention resources, specially those children with severe asthma.

Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea

We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.

Impact socio-économique de la maladie asthmatique à Bamako à propos de 131 cas

Dans le but d'évaluer l'impact socio-économique de la maladie asthmatique au Mali, une étude transversale a été réalisée du 1er juillet au 30 septembre 2006 dans le district de Bamako. L'étude s'est déroulée au service de Pneumo-phtisiologie du CHU du point G et dans 4 des 6 centres de santé de référence du district tirés au sort. 131 malades asthmatiques ont été répertoriés sur 1595 consultations soit une fréquence de 8,24%. La moyenne d'âge était de 31 ans, le sex-ratio était de 1,2 en faveur des hommes. Le mois d'Août a enregistré le plus grand nombre de consultation soit 50,4%. L'antécédent d'asthme familial a été retrouvé dans 46,6% des cas, le tabagisme dans 13% des cas. Le coût thérapeutique moyen par an s'élevait de 75.750 FCFA soit 115,47 EUROS sans hospitalisation à 222.750 FCFA (339,57 EUROS) avec hospitalisation. Les frais d'hospitalisations s'élevaient en moyenne à 147.000 FCFA (224,09 EUROS) soit 66,21% des coûts de prise en charge. La durée moyenne d'hospitalisation était de 5,5 jours1 à 4 jours sans activité ont été notés chez 50,4% des cas, en moyenne 312 jours d'absence. Le dommage professionnel a été signalé dans 13,7%. Le fardeau économique était supporté par le père dans 29% des cas. Dans 42% des cas le chargé de dépense était fonctionnaire

Epidemiology and current status of asthma and associated allergic diseases in Taiwan- ARIA Asia-Pacific Workshop report.

The prevalence of allergic diseases appears to have been increasing in recent years. The hospitalization rate of asthma in children showed an increasing trend. House dust mites and cockroaches are the two most common indoor aeroallergens in Taiwan. Various kinds of inhaled corticosteroids or combination medications are available, but in clinical practice these have not been used as much as oral beta-2 agonists. Generally 68% of the physicians would follow the asthma treatment guidelines. Because of the comprehensive health care insurance system, the majority of the population in Taiwan can afford the medical expense of diseases. The country's expenditure of asthma care is around USD 83.1 millions per year which is increasing by the year as well. In clinical aspects, asthma education should still be included as part of its treatment.

Effect of Allergic Rhinitis on the Use and Cost of Health Services by Children with Asthma

PURPOSE: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. MATERIALS and METHODS: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. RESULTS: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were dollar 273 and dollar 217 for children with and without AR, respectively. CONCLUSION: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.

Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients

Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2 percent) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.

Impacto de um programa para o controle da asma grave na utilização de recursos do Sistema Unico de Saúde / Impact that a program to control severe asthma has on the use of Unified Health System resources in Brazil

OBJETIVO: Quantificar a redução da utilização de recursos da saúde entre pacientes admitidos no Programa para o Controle da Asma e Rinite Alérgica na Bahia. MÉTODOS: Até o mês de janeiro de 2006 havia 1.405 pacientes inscritos no programa, em quatro centros de referência em Salvador (BA). Foram incluídos, na análise preliminar, 269 pacientes consecutivos com diagnóstico de asma grave e idade superior a doze anos. Os pacientes tinham assistência de pneumologistas, enfermeiros, farmacêuticos e psicólogos e recebiam medicações inalatórias para asma. Neste estudo observacional de coorte prospectivo, foram comparados os números de internações, de atendimentos em emergência, de ciclos de corticóide sistêmico e de dias de ausência da escola ou do trabalho por crise de asma, no ano anterior à admissão no programa, com base no relato dos pacientes, com o registro da ocorrência destes eventos no primeiro ano de acompanhamento no programa. RESULTADOS: Nesta amostra de pacientes com asma grave o programa resultou em redução significativa dos atendimentos de emergência (de 85 por cento) e redução do número de internações hospitalares (de 90 por cento). Houve também uma redução no número de dias de ausência da escola ou trabalho (de 86 por cento) e no número de ciclos de corticóide sistêmico (de 67 por cento). CONCLUSÃO: Um programa para o controle da asma grave em ambulatório de referência, incluindo assistência farmacêutica gratuita, permite acentuada redução no consumo de recursos do Sistema Unico de Saúde.

OBJECTIVE: To quantify the use of health care resources among patients enrolled in the Bahia State Asthma and Allergic Rhinitis Control Program. METHODS: As of January of 2006, 1405 patients had enrolled in the program, which is carried out in four referral centers in the city of Salvador. These patients formed the basis of this retrospective/prospective, observational cohort study. The preliminary analysis involved 269 consecutive patients, all above the age of 12 and diagnosed with severe asthma. After being seen by pulmonologists, nurses, pharmacologists and psychologists, the patients received inhaled asthma medications. Based on patient interviews and charts, the year preceding enrollment in the program was compared with the first year enrolled in the program in terms of the following quantifiable parameters: hospital admissions; emergency room visits; courses of oral corticosteroids; and days of school/work missed due to asthma attacks. RESULTS: In this sample of patients with severe asthma, enrollment in the program resulted in significant reductions in the number of emergency room visits and hospital admissions (of 85 percent and 90 percent, respectively). There were also reductions in the number of school/work days missed due to asthma attacks and in the number of courses of oral corticosteroids (of 86 percent and 67 percent, respectively). CONCLUSION: A program designed to control severe asthma in referral outpatient clinics and including pharmacological services at no charge can lead to a pronounced reduction in the demand for Unified Health Care System resources.

Comparison of total cost of health services among asthmatic and COPD patients in Uni-Speciality hospital with General hospital

Based on econometric studies conducted worldwide and in Iran, one of the methods by which the efficiency and effectiveness of an organization is evaluated, is by cost-control methods and economical analyses of therapeutic activities that must be carried out routinely and periodically. It seems that services offered in uni-speciality hospitals are cheaper than general hospitals. This study aims to propose a model by which the provided services can be expanded in a specific field of treatment. Also this study was conducted to analyse and compare the costs of asthma and COPD in two general and uni-speciality hospitals in order to determine the total services costs of these two diseases. This cross-sectional retrospective experimental study calculated hospital costs and analysed the data in forms and tables designed especially for this purpose. Also data in regard to capital, current and overhead costs were collected. After calculation, the mean of total costs in both diseases was assessed. In this study, econometric analyses of asthma and COPD demonstrated that the health services cost of asthma in a general hospital was 1.19 times greater than that of a uni-speciality hospital, while the services cost of COPD in a general hospital was 1.36 times that of uni-speciality hospital. The difference in costs includes duration of hospitalization, cost of paraclinical and diagnostic tests, counselling, medical equipments, and overhead costs. As it is observed all over the world, health care personnel pay less attention to the costs of medical equipment and are less aware of the economical aspect of health care services,. Without considering the costs, physicians are always after new equipment. Having knowledge about the costs is not only essential for hospital administrators but also for all medical personnel, since with more cost reduction, a greater number of people can enjoy medical services

The Current Status of Asthma in Korea

A systematic review of English and Korean articles published between 1990 and 2004 and a search of database and various online resources was conducted to determine the prevalences, mortality rates, socioeconomic burden, quality of life, and treatment pattern of asthma in Korean adults and children. Asthma morbidity and mortality in Korea are steadily increasing. The prevalence of asthma in Korea is estimated to be 3.9% and its severity is often underestimated by both physicians and patients. Mortality resulting from chronic lower respiratory diseases including asthma increased from 12.9 to 22.6 deaths per 100,000 of the population between 1992 and 2002. Disease severity, level of control, and symptom state were all found to negatively impact the quality of life of asthmatics. Although international and Korean asthma management guidelines are available, familiarity with and implementation of these guidelines by primary care physicians remain poor.

Medical charge of asthma care in admitted Thai children.

BACKGROUND: Asthma is one of the most common chronic diseases in children. Due to high admission rate for acute asthmatic attack, children often miss their schools and parents have to stop working to take care of them. These affect both mental and physical health as well as socioeconomic status of the family and the country. OBJECTIVES: To evaluate medical charge of asthma care in children admitted to the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: The study was a retrospective and descriptive study. Data were collected from children with asthmatic attack admitted to the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from January 1st, 2000 to June 30th, 2003. Cost of room, food, drugs, devices, laboratory study and service charge were recorded. Total medical charges per year, per patient per admission and per patient per day were calculated. Data were analyzed with Chi square test, ANOVA and Post Hoc test. A p value of < 0.05 was considered statistical significant. RESULTS: Numbers of children with asthmatic attack admitted to the Department of Pediatrics, Siriraj Hospital increased between 2000-2002 (113,147 and 176 in 2000, 2001, and 2002). Seventy two percent of the patients were < or = 5 years of age. Most were mild intermittent asthma. The average duration of hospitalization was 4 days (95% CI, 3.6-4.3). Average medical charge per patient per admission and per day was 3236.20 and 998.60 Bahts respectively. There was no significant difference in the medical charge per patient among the admitted years. Medical charge of admission was significantly associated with the asthma severity. (p < or = 0.05) CONCLUSION: The rate of admission from asthmatic attack in children at Siriraj Hospital and the total medical charge per year increased between 2000-2002. Nevertheless, medical charge of asthma admission per person was unchanged. Main expense in medical charge of asthma admission was the cost of medication and room. Severity of asthma was related directly to medical charge.

Social and economic impact of childhood asthma.

In order to assess the social, educational and economic impact in children with asthma and their families, we studied 162 children with bronchial asthma. The patients and their parents were interviewed to assess the restriction on various activities of the child and family, the impact on schooling and expenditure on therapy. One hundred and forty one (87%) children had either mild or moderate persistent asthma. Nearly two thirds of children had some restriction placed on their play activities because of asthma. Restrictions on other physical activities and social activities were reported in half the children. Children had absented from school for a median of 4 days in preceding 6 months. All these restrictions were more common in children with more severe disease and/or poor control of symptoms. The median monthly expenditure on child's medication was Rs. 333, i.e., about one third of monthly per capita income. Childhood asthma has significant adverse impact on child's daily activities, schooling, and family life and finances.