OBJECTIVES : We assessed disease and economic burden of severe asthma in India by studying patient demographics, referral pathways, resource utilization, and associated management costs.

METHODS : We conducted an informal literature review on prevalence, patient demographics, and diagnosis, followed by qualitative and quantitative analyses on treatment pathways and disease management costs. We interviewed 90 general/consulting physicians, specialists with ≥5 years’ experience (approximately 1–2 physicians/hospital), and 30 patients ≥1 hospitalization/year (identified as per physician referral) across 90 hospitals from Metro/Tier-1 cities. Physicians provided input on data points, supplemented with patient input on disease management costs. Findings were re-validated qualitatively by experts

RESULTS : 36% of total outpatient respiratory patient load was from asthma, with 21% having severe asthma (GINA criteria). Poor compliance with follow up for severe asthma patients was indicated (1 OPD visit/4–5 months). 75% of severe asthma patients experienced an average of ≥2 exacerbations/year, and 57% of severe asthmatics were managed at emergency room (3–4 visits/ year), and 38% required hospitalization (2–3 visits/year), with average stay of 2–5 days/episode. 5% required ICU admissions (approximately 1 admission/year), with stays of 1–4 days. Research indicated a 20–30% decline in patient follow-up visits post-hospitalization.

Average annual cost of disease management per severe asthma patient was INR 1,18,303 (USD 1,602). The breakdown of costs were drug costs, INR 22,328/USD 302; diagnosis, INR 4,065/USD 55); and hospitalization, INR 91,910/USD 1,242). IV corticosteroids costs were greatest, followed by ICS+LABA and OCS.

CONCLUSIONS

Severe asthma management is riddled with challenges around disease awareness and patient compliance, leading to substantial disease management costs. This underlines need for better disease control in severe asthma, especially for resource-constrained health care systems, including India