Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30–54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30–54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.

Weiss KB, Sullivan SD: The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol 2001;107:3–8.
Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM: Economic burden of asthma: a systematic review. BMC Pulm Med 2009;9:24.
Accordini S, Bugiani M, Arossa W, Gerzeli S, Marinoni A, Olivieri M, Pirina P, Carrozzi L, Dallari R, De Togni A, de Marco R: Poor control increases the economic cost of asthma. A multicentre population-based study. Int Arch Allergy Immunol 2006;141:189–198.
Accordini S, Corsico A, Cerveri I, Gislason D, Gulsvik A, Janson C, Jarvis D, Marcon A, Pin I, Vermeire P, Almar E, Bugiani M, Cazzoletti L, Duran-Tauleria E, Jõgi R, Marinoni A, Martínez-Moratalla J, Leynaert B, de Marco R: The socio-economic burden of asthma is substantial in Europe. Allergy 2008;63:116–124.
Masoli M, Fabian D, Holt S, Beasley R: The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy 2004;59:469–478.
Henderson JW: Health Economics and Policy, ed 4. Mason, South-Western Cengage Learning, 2009.
Tarricone R: Cost-of-illness analysis. What room in health economics? Health Policy 2006;77:51–63.
Van Ganse E, Antonicelli L, Zhang Q, Laforest L, Yin DD, Nocea G, Sazonov Kocevarc V: Asthma-related resource use and cost by GINA classification of severity in three European countries. Respir Med 2006;100:140–147.
Williams AE, Lloyd AC, Watson L, Rabe KF: Cost of scheduled and unscheduled asthma management in seven European Union countries. Eur Respir Rev 2006;15:4–9.
Vervloet D, Williams AE, Lloyd A, Clark TJH: Costs of managing asthma as defined by a derived Asthma Control Test™ score in seven European countries. Eur Respir Rev 2006;15:17–23.
Siroux V, Boudier A, Anto JM, Cazzoletti L, Accordini S, Alonso J, Cerveri I, Corsico A, Gulsvik A, Jarvis D, de Marco R, Marcon A, Marques EA, Bugiani M, Janson C, Leynaert B, Pin I: Quality-of-life and asthma-severity in general population asthmatics: results of the ECRHS II study. Allergy 2008;63:547–554.
Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B: Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000;343:332–336.
European Community Respiratory Health Survey II Steering Committee: The European Community Respiratory Health Survey II. Eur Respir J 2002;20:1071–1079.
Burney PG, Luczynska C, Chinn S, Jarvis D: The European Community Respiratory Health Survey. Eur Respir J 1994;7:954–960.
Global Initiative for Asthma: Global strategy for asthma management and prevention, 2002.
Cazzoletti L, Marcon A, Corsico A, Janson C, Jarvis D, Pin I, Accordini S, Bugiani M, Cerveri I, Gislason D, Gulsvik A, de Marco R: Asthma severity according to Global Initiative for Asthma and its determinants: an international study. Int Arch Allergy Immunol 2010;151:70–79.
Global Initiative for Asthma: Global strategy for asthma management and prevention, 2006.
Cazzoletti L, Marcon A, Janson C, Corsico A, Jarvis D, Pin I, Accordini S, Almar E, Bugiani M, Carolei A, Cerveri I, Duran-Tauleria E, Gislason D, Gulsvik A, Jõgi R, Marinoni A, Martínez-Moratalla J, Vermeire P, de Marco R: Asthma control in Europe: a real-world evaluation based on an international population-based study. J Allergy Clin Immunol 2007;120:1360–1367.
Segel JE: Cost-of-illness studies – a primer. Research Triangle Park, RTI International, 2006.
Gergen PJ: Understanding the economic burden of asthma. J Allergy Clin Immunol 2001;107(suppl 5):S445–S448.
Efron B, Tibshirani RJ: An introduction to the bootstrap. New York, Chapman & Hall/CRC, 1993.
Cameron AC, Trivedi PK: Regression analysis of count data. Cambridge, Cambridge University Press, 1998.
Council of Europe: Recent demographic developments in Europe, 2004. Strasbourg, Council of Europe Publishing, 2005.
Loddenkemper R, Gibson GJ, Sibille Y (eds): European Lung White Book. The first comprehensive survey on respiratory health in Europe. Sheffield, European Respiratory Society, 2003.
Antonicelli L, Bucca C, Neri M, De Benedetto F, Sabbatani P, Bonifazi F, Eichler HG, Zhang Q, Yin DD: Asthma severity and medical resource utilisation. Eur Respir J 2004;23:723–729.
Stock S, Redaelli M, Luengen M, Wendland G, Civello D, Lauterbach KW: Asthma: prevalence and cost of illness. Eur Respir J 2005;25:47–53.
Serra-Batlles J, Plaza V, Morejón E, Comella A, Brugués J: Costs of asthma according to the degree of severity. Eur Respir J 1998;12:1322–1326.
National Institutes of Health, National Heart Lung and Blood Institute, Global Initiative for Asthma: Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report. NIH Publication No. 95-3659. Bethesda, NIH, 1995.
Janson C, de Marco R, Accordini S, Almar E, Bugiani M, Carolei A, Cazzoletti L, Cerveri I, Corsico A, Duran-Tauleria E, Gislason D, Gulsvik A, Jõgi R, Marinoni A, Martínez-Moratalla J, Pin I, Vermeire P, Jarvis D: Changes in the use of anti-asthmatic medication in an international cohort. Eur Respir J 2005;26:1047–1055.
Revicki D, Weiss KB: Clinical assessment of asthma symptom control: review of current assessment instruments. J Asthma 2006;43:481–487.
Demoly P, Gueron B, Annunziata K, Adamek L, Walters RD: Update on asthma control in five European countries: results of a 2008 survey. Eur Respir Rev 2010;19:150–157.
Kupczyk M, Haahtela T, Cruz AA, Kuna P: Reduction of asthma burden is possible through National Asthma Plans. Allergy 2010;65:415–419.
Barnes PJ, Jonsson B, Klim JB: The costs of asthma. Eur Respir J 1996;9:636–642.
de Marco R, Bugiani M, Cazzoletti L, Carosso A, Accordini S, Buriani O, Carrozzi L, Dallari R, Giammanco G, Ginesu F, Marinoni A, Lo Cascio V, Poli A, Struzzo P, Janson C: The control of asthma in Italy. A multicentre descriptive study on young adults with doctor diagnosed current asthma. Allergy 2003;58:221–228.
de Marco R, Marcon A, Jarvis D, Accordini S, Almar E, Bugiani M, Carolei A, Cazzoletti L, Corsico A, Gislason D, Gulsvik A, Jõgi R, Marinoni A, Martínez-Moratalla J, Pin I, Janson C: Prognostic factors of asthma severity: a 9-year international prospective cohort study. J Allergy Clin Immunol 2006;117:1249–1256.
Buist AS: Similarities and differences between asthma and chronic obstructive pulmonary disease: treatment and early outcomes. Eur Respir J Suppl 2003;39:30s–35s.
de Marco R, Accordini S, Cerveri I, Corsico A, Antó JM, Künzli N, Janson C, Sunyer J, Jarvis D, Chinn S, Vermeire P, Svanes C, Ackermann-Liebrich U, Gislason T, Heinrich J, Leynaert B, Neukirch F, Schouten JP, Wjst M, Burney P: Incidence of chronic obstructive pulmonary disease in a cohort of young adults according to the presence of chronic cough and phlegm. Am J Respir Crit Care Med 2007;175:32–39.
Lavoie KL, Bacon SL, Labrecque M, Cartier A, Ditto B: Higher BMI is associated with worse asthma control and quality of life but not asthma severity. Respir Med 2006;100:648–657.
King GG, Brown NJ, Diba C, Thorpe CW, Muñoz P, Marks GB, Toelle B, Ng K, Berend N, Salome CM: The effects of body weight on airway calibre. Eur Respir J 2005;25:896–901.
Shore SA, Fredberg JJ: Obesity, smooth muscle, and airway hyperresponsiveness. J Allergy Clin Immunol 2005;115:925–927.
Romanet-Manent S, Charpin D, Magnan A, Lanteaume A, Vervloet D: Allergic vs nonallergic asthma: what makes the difference? Allergy 2002;57:607–613.
de Marco R, Locatelli F, Cerveri I, Bugiani M, Marinoni A, Giammanco G: Incidence and remission of asthma: a retrospective study on the natural history of asthma in Italy. J Allergy Clin Immunol 2002;110:228–235.
Weiss KB, Sullivan SD, Lyttle CS: Trends in the cost of illness for asthma in the United States, 1985–1994. J Allergy Clin Immunol 2000;106:493–499.
Jacobson L, Hertzman P, Löfdahl CG, Skoogh BE, Lindgren B: The economic impact of asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991. Respir Med 2000;94:247–255.
Mancuso CA, Rincon M, Charlson ME: Adverse work outcomes and events attributed to asthma. Am J Ind Med 2003;44:236–245.
Sapra S, Nielsen K, Martin BC: The net cost of asthma to North Carolina Medicaid and the influence of comorbidities that drive asthma costs. J Asthma 2005;42:469–477.
Evans C, Crawford B: Patient self-reports in pharmacoeconomic studies. Their use and impact on study validity. Pharmacoeconomics 1999;15:241–256.
Bhandari A, Wagner T: Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006;63:217–235.
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