The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases

Mome Mukherjee, Andrew Stoddart, Ramyani P Gupta, Bright I Nwaru, Angela Farr, Martin Heaven, Deborah Fitzsimmons, Amrita Bandyopadhyay, Chantelle Aftab, Colin R Simpson, Ronan A Lyons, Colin Fischbacher, Christopher Dibben, Michael D Shields, Ceri J Phillips, David P Strachan, Gwyneth A Davies, Brian McKinstry, Aziz Sheikh, Mome Mukherjee, Andrew Stoddart, Ramyani P Gupta, Bright I Nwaru, Angela Farr, Martin Heaven, Deborah Fitzsimmons, Amrita Bandyopadhyay, Chantelle Aftab, Colin R Simpson, Ronan A Lyons, Colin Fischbacher, Christopher Dibben, Michael D Shields, Ceri J Phillips, David P Strachan, Gwyneth A Davies, Brian McKinstry, Aziz Sheikh

Abstract

Background: There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma.

Methods: We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010-11, and routine administrative, health and social care datasets for 2011-12; 2011-12 costs were estimated in pounds sterling using economic modelling.

Results: The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7-31.3; n = 18.5 million (m) people) and 15.6 % (14.3-16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9-10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7-5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths.

Conclusions: Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs.

Keywords: Asthma; Burden; Cost; Epidemiology; UK.

References

    1. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, Group tIPTS International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergologia et Immunopathologia. 2013;41(2):73–85. doi: 10.1016/j.aller.2012.03.001.
    1. Gupta R, Sheikh A, Strachan DP, Anderson HR. Burden of allergic disease in the UK: secondary analyses of national databases. Clin Exp Allergy. 2004;34(4):520–6. doi: 10.1111/j.1365-2222.2004.1935.x.
    1. Anandan C, Gupta R, Simpson C, Fischbacher C, Sheikh A. Epidemiology and disease burden from allergic disease in Scotland: analyses of national databases. JRSM. 2009;102(10):431–42. doi: 10.1258/jrsm.2009.090027.
    1. Anandan C, Nurmatov U, van Schayck OC, Sheikh A. Is the prevalence of asthma declining? Systematic review of epidemiological studies. Allergy. 2010;65(2):152–67. doi: 10.1111/j.1398-9995.2009.02244.x.
    1. Bahadori K, Doyle-Waters M, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM. Economic burden of asthma: a systematic review. BMC Pulm Med. 2009;9:24. doi: 10.1186/1471-2466-9-24.
    1. Levy ML. The national review of asthma deaths: what did we learn and what needs to change? Breathe. 2015;11(1):14–24. doi: 10.1183/20734735.008914.
    1. Mukherjee M, Gupta R, Farr A, Heaven M, Stoddart A, Nwaru BI, Fitzsimmons D, Chamberlain G, Bandyopadhyay A, Fischbacher C, et al. Estimating the incidence, prevalence and true cost of asthma in the UK: secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales—a study protocol. BMJ Open. 2014;4(11):e006647. doi: 10.1136/bmjopen-2014-006647.
    1. Curtis L, Personal Social Services Research Unit (PSSRU) University of Kent. Unit Costs of Health and Social Care 2012. 2012. . Accessed 7 March 2016.
    1. Office of National Statistics. Population estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2001 to Mid-2010 Revised. 2013. . Accessed 3 March 2016.
    1. Office for National Statistics. Population estimates for UK, England and Wales, Scotland and Northern Ireland, Mid 2011. Estimates of the usual resident population for the UK as at 30 June of the reference year Provided by administrative area, single year of age and sex 2013. . Accessed 3 March 2016.
    1. British National Formulary. 2012. . Accessed 3 March 2016.
    1. World Health Organization. International Classification of Disease-10. . Accessed 3 March 2016.
    1. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619–36. doi: 10.1378/chest.100.6.1619.
    1. Department for Work & Pensions. . Accessed 26 April 2016.
    1. Royal College of General Practitioners. RCGP Research and Surveillance Centre. . Accessed 13 May 2016.
    1. Information Services Division. NHS National Services. GP Consultations/Practice Team Information (PTI) Statistics. . Accessed 13 May 2016.
    1. Secure Anonymised Information Linkage (SAIL). . Accessed 3 March 2016.
    1. Last J, Porta M. A Dictionary of Epidemiology. 5. New York: Oxford University Press; 2008.
    1. UK Data Service. Health Survey for England, 2010. . Accessed 13 May 2016.
    1. UK Data Service. Scottish Health Survey, 2010. . Accessed 13 May 2016.
    1. Government of Wales. Welsh Health Survey, 2010. . Accessed 13 May 2016.
    1. Department of Health Northern Ireland. Health Survey Northern Ireland, 2010. . Accessed 13 May 2016.
    1. Nwaru BI, Mukherjee M, Gupta RP, Farr A, Heaven M, Stoddart A, Bandyopadhyay A, Fitzsimmons D, Shields M, Phillips C, et al. Challenges of harmonising data from UK national health surveys: a case study of attempts to estimate the UK prevalence of asthma. J R Soc Med. 2015;108:433–9. doi: 10.1177/0141076815600909.
    1. Health and Social Care Information Centre. Quality and Outcomes Framework. . Accessed 7 May 2016.
    1. Information Services Division NHS National Services. Quality & Outcomes Framework. . Accessed 10 May 2016.
    1. Department of Health Northern Ireland. Quality and Outcomes Framework Achievement Data 2011/12. . Accessed 13 May 2016.
    1. Welsh Government. General Medical Services Contract: Quality and Outcomes Framework. 2011–12. . Accessed 13 May 2015.
    1. Health and Social Care Information Centre, UK Government. Indicators for Quality Improvement, Quality and Outcomes Framework, Outcomes framework domain classification of IQI indicators. 2011–12. . Accessed 27 Apr 2016.
    1. HSC Business Services Organisation. Prescription Cost Analysis. 2011. . Accessed 13 May 2016.
    1. Health and Social Care Information Centre, England. Prescription Cost Analysis – England, 2011, 2012 [NS]. 2011, 2012 ; . Accessed 26 Apr 2016.
    1. Information Services Division, NHS National Services Scotland. Prescription Cost Analysis. 2011, 2012. . Accessed 26 Apr 2016.
    1. Welsh Government. Prescriptions dispensed in the community. Prescription Cost Analysis. 2011, 2012. . Accessed 26 Apr 2016.
    1. NHS 24 Scotland’s National Telehealth and Telecare Organisation. NHS Inform. . Accessed 13 May 2016.
    1. Scottish Ambulance Service. . Accessed 13 May 2016.
    1. Information Services Division NHS National Services. Accident and Emergency (A&E) Data Mart. . Accessed 13 May 2016.
    1. Secure Anonymised Information Linkage. Emergency Department Data Set. . Accessed 3 March 2016.
    1. Health and Social Care Information Centre. Hospital Episode Statistics, Admitted patient care. . Accessed 26 Apr 2016.
    1. Information Services Division Scotland. Publications-Hospital Care. . Accessed 26 Apr 2016.
    1. Public Health Wales Observatory. Patient Episode Database for Wales. . Accessed 10 Sept 2014.
    1. Department of Health, Northern Ireland. Hospital Statistics. . Accessed 13 May 2016.
    1. Paediatric Intensive Care Audit Network. Details of the data collected by PICANet are given in their annual reports. Paediatric Intensive Care Audit Network Annual Report 2012 - 2014 (published 2015): Universities of Leeds and Leicester. . Accessed 13 May 2016.
    1. Intensive Care National Audit & Research Centre. . Accessed 13 May 2016.
    1. Scottish Intensive Care Society Audit Group. . Accessed 13 May 2016.
    1. Department for Communities in Northern Ireland. . Accessed 13 May 2016.
    1. Office for National Statistics. All data related to deaths. . Accessed 13 May 2016.
    1. National Records Scotland (NRS). Deaths. 2011. . Accessed 26 Apr 2016.
    1. Northern Ireland Statistics and Research Agency website (NISRA). Deaths. . Accessed 10 Sept 2014.
    1. Eurostat - Statistical Office of the European Union. Revision of the European Standard Population. Report of Eurostat’s task force. Version 2013. . Accessed 3 March 2016.
    1. Scottish Public Health Observatory. Standardisation-worked examples, 95 % C.I. for EASR (Poisson approximation). . Accessed 3 March 2016.
    1. Department of Health. NHS reference costs 2011–12. . Accessed 3 March 2016.
    1. Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327–40. doi: 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>;2-W.
    1. Briggs A, Claxton K, Sculpher M. Decision modelling for health economic evaluation. New York: Oxford University Press; 2006.
    1. British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma: A national clinical guideline. 2014. . Accessed 3 March 2016.
    1. Gosselin E, Lemyre L, Corneil W. Presenteeism and absenteeism: differentiated understanding of related phenomena. J Occup Health Psychol. 2013;18(1):75–86. doi: 10.1037/a0030932.
    1. National Institute for Health and Clinical Excellence. Technology Appraisal Guidance 278. Omalizumab for treating severe persistent allergic asthma (review of technology appraisal guidance 133 and 201). 2013 . Accessed 3 March 2016.
    1. Global Asthma Network. The Global Asthma Report 2014. Auckland: GAN; 2014.
    1. Torpy JM, Campbell A, Glass RM. Chronic diseases of children. JAMA. 2010;303(7):682. doi: 10.1001/jama.303.7.682.
    1. Patel SP, Jarvelin MR, Little MP. Systematic review of worldwide variations of the prevalence of wheezing symptoms in children. Environ Health. 2008;10:7–57.
    1. Anderson HR, Gupta R, Strachan DP, Limb E. 50 years of asthma: UK trends from 1955 to 2004. Thorax. 2007;62(1):85–90. doi: 10.1136/thx.2006.066407.
    1. Gupta R, Anderson HR, Strachan DP, Maier W, Watson L. International trends in admissions and drug sales for asthma. Int J Tuberc Lung Dis. 2006;10(2):138–45.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe