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PAS1 |
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ESTIMATING ECONOMIC BURDEN OF
CHILDHOOD ASTHMA IN KOREA USING THE NATIONAL
HEALTH INSURANCE CLAIMS DATA
Kang HY1, Park CS2, Bang HR3, Kocevar VS4,
Kim CJ3, 1Yonsei University, Seoul, South Korea,
2Korea University, Seoul, South Korea, 3MSD Korea
LTD, Seoul, South Korea, 4Merck & Co., Inc,
Whitehouse Station, NJ, USA OBJECTIVE:
To determine
asthma-related healthcare utilization and costs
among children with asthma in Korea. METHODS:
We conducted a burden-of-illness study of
childhood asthma from the societal perspective.
Asthma-related claims in 2003 were extracted from
the Korean National Health Insurance claims
database. Children (1 to 14 years old) were
included in the study if they had two or more
medical claims with diagnosis of asthma and
prescription for anti-asthma medicines. The total
asthma-related cost was the sum of the direct
healthcare costs, transportation costs for visits
to healthcare providers, and caregivers’
opportunity costs for the time spent on hospital
or outpatient visits. Direct healthcare costs
included the costs of outpatient visits, emergency
department (ED) visits, hospital admissions, and
pharmaceuticals. RESULTS:
A total of
319,714 children with asthma were identified,
yielding a one-year asthma prevalence of 3.5%.
Asthmatic children had average of 7.82 outpatient
visits, 0.02 ED visits, 0.01 admissions, and 0.05
inpatient days per year were recorded. The total
cost of insured healthcare services used to treat
asthma was $39 million, representing 0.25% of the
total expenditure on insured healthcare services
in Korea. Outpatient care accounted for 52.6% of
the total expenditure on insured services,
inpatient care for 2.1%, ED visits for 0.3%, and
prescribed medicines for 45.0%. Direct healthcare
costs accounted for 84.6%, transportation costs
for 8.5%, and time costs for 7.0% of the $66.8
million total cost of treating childhood asthma.
CONLUSIONS:
Most of the societal economic
burden of childhood asthma was attributable to
direct healthcare expenditures, with outpatient
visits and medications emerging as the largest
component costs. Hospitalizations and ED visits
represented a smaller fraction of the cost of
childhood asthma in Korea than in other countries.
Key words: Asthma, burden of illness, claims data,
health care utilizationn
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PAS2 |
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IS IT WORTH TO USE INHALED
CORTICOSTEROIDS TO CONTROL MILD-TO-MODERATE ASTHMA
UNDER THE THAI HEALTH CARE CONTEXT?
Limwattananon C1, Limwattananon S1,
Saklertsakul D1, Phumas P2, 1Khon Kaen University,
Amphoe Muang, Khon Kaen, Thailand, 2Mahasarakham
University, Amphoe Muang, Mahasarakham, Thailand OBJECTIVE:
To
determine an incremental cost-effectiveness ratio
(ICER) for budesonide, an inhaled costicosteroid
(ICS), used with salbutamol, a short acting beta-2
agonist inhaler, compared with salbutamol alone in
patients with mild or moderate asthma. METHODS:
Data on drug effects were obtained from Asthma
Policy Model. Cost data were abstracted from
databases of hospitals in Thailand. Under health
care provider perspective, a Markov model
estimated life expectancy adjusted by quality of
life and health care cost over a tenyear period.
RESULTS:
For a patient aged 18-35 years
with mild asthma and no prior hospitalization, use
of ICS in addition to beta-2 agonist extended the
patient life by 2.78 quality-adjusted life month (QALM)
and saved health care cost of 7,328 Baht in total
(40 Baht = 1 USD). A gain in QALM associated with
the ICS use did not vary across variations in
patient age, asthma severity, and prior experience
of hospital admission. The amount of saving
increased with respect to an increase in ages,
asthma severity, and frequency of admissions. The
most cost saving strategy was the use of ICS in
patients over 35 years who had moderate asthma and
had been admitted to hospitals more than once,
where the cost saving increased to 43,373 Baht.
Cost difference between the competing drugs was
also sensitive to duration of drug use. For 3
years of drug use, an additional one
qualityadjusted life year (QALY) gained due to the
ICS use was offset by an increase of 3,255 Baht,
on average, in the health care cost.
CONLUSIONS:
Adding ICS to beta-2 agonist is
cost-effective for treatment of mild and moderate
asthma in Thai context based on a threshold of
three times of per capita income (GNI of 2,190 USD
for Thailand) as suggested by the World Health
Organization’s Commission on Macroeconomics and
Health.
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PAS3 |
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FIVE-YEAR CLAIM DATABASE
ANALYSIS OF ASTHMA IN TAIWAN
Lu CH1, Tarn YH2, 1Armed Forces Beitou
Hospital, Taipei, Taiwan, 2Taipei City Hospital,
Taipei, Taiwan The National Health
Insurance (NHI) program was officially launched on
March 1th, 1995, in Taiwan for ten years. The
balance of revenues and expenditure was stable
initially, but a deficit was shown since 1998.
Health-related retrospective databases, in
particular claims databases, continue to be an
important data source for outcomes research.
OBJECTIVE:
1) To compare the asthma prevalence
from the consecutive claimed-database to published
results. 2) To understand trends of medical
resources utilization of asthma in Taiwan. 3) To
understand the improvement of asthmatic care in
Taiwan. METHODS:
During the year 1998 to
2002, claims with primary and secondary diagnosis
of asthma in their ICD-9-CM code and A-code were
obtained and then sorted per person to obtain
their whole medical resource utilization. Those
data files included ambulatory care expenditures
by visits, details of ambulatory care orders,
inpatient expenditures by admissions and details
of inpatient orders. The STATA 8.0 and SAS 8.2
computer softwares were used to perform the
analysis. RESULTS:
1) The prevalence of
asthmatic patients form 1998 to 2002, from primary
diagnosis, was 8.84%, 3.48%, 2.24%, 2.20% and
2.15%, respectively. 2)Number of Outpatient
visited per person per year was from 2.07(1998) to
3.17(2002). Average prescription days per person:
from 7.25(1998) to 12.08(2002). Number of
hospitalization per person per year: from
0.02(1998) to 0.07(2002). Number of emergency
visited per person per year: from 0.05(1998) to
0.14(2002). 3)Total cost per year: US$ 10, 7.2,
5.9, 6.3 and 6.9 million dollars. 4) The ratio of
drug costs/total costs about 45%. CONLUSIONS:
Condition of asthmatic outpatient care was
improving and inpatient care was worsen. The ratio
of drug costs plays an important role in asthmatic
care.
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PAS4 |
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THAI PATIENTS’ EXPERIENCE OF
THE BURDEN OF ASTHMA: QUALITATIVE STUDY
Sirimai P1, Limwattananon C2, Limwattananon
S2, Tangcharoensathien V3, Boonsawat W4, Schommer
JC5, 1Prachuapkhirikhan Hospital,
Prachuapkhirikhan, Thailand, 2Khon Kaen
University, Amphoe Muang, Khon Kaen, Thailand,
3International Health Policy Program, Nonthaburi,
Thailand, 4Khon Kaen University, Khon Kaen,
Thailand, 5University of Minnesota, Minneapolis,
MN, USA
OBJECTIVE:
To describe the burden of asthma among
Thai patients. Design: Qualitative study with
semi-structured in-depth interviews. METHODS:
A
secondary hospital in the upper south of Thailand.
Participants: 52 asthmatic patients aged 18-60
years experiencing in emergency department visits
in 2003. RESULTS:
The burden of asthma affecting
Thai patients on mainly four categories relating
to daily life including physical and emotional
impact, employment, financial, and partners
relationships. Suffering from asthma symptoms was
stated in most participants with poorly controlled
asthma. Emotions of fear and panic appeared from
asthma attack in all patients. Suicidal idea from
disease and financial problems took place in some
participants. In persistent asthmatic patients,
feelings of exhaustion and tiredness frequently
happened and caused of omitting therapy in some
participants. Financial problems occurred from
losing or changing jobs or losing income affecting
patients who were chief of the family. Partner
relationships could end up with divorce due to
financial problems. The cost of asthma medication
was not an issue in most patients since universal
coverage was implemented at a nationwide scale.
Our current understanding of the
patients’ experience of the burden of asthma
contributes to improving the management and
control of asthma and enabling patients to live
full, active and productive lives. |
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