The projected economic and health burden of uncontrolled asthma in the United States

Rationale Despite effective treatments, a large proportion of asthma patients do not achieve sustained asthma control. The ‘preventable’ burden associated with lack of proper control is likely taking a high toll at the population level. Objective We predicted the future health and economic burden of uncontrolled asthma among American adults for the next 20 years. Methods We built a probabilistic model that linked state-specific estimates of population growth, asthma prevalence rates, and distribution of asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state-level, total direct and indirect costs (in 2018 USD) and QALYs lost due to uncontrolled asthma from 2019 to 2038 in the United States. Measurements and Main Results Over the next 20 years, the total undiscounted direct costs associated with suboptimal asthma control will be $300.6 billion (95% confidence interval [CI] $190.1 – $411.1). When indirect costs are added, total economic burden will be $963.5 billion (95%CI $664.1 – $1,262.9). American adolescents and adults will lose 15.46 million (95%CI 12.77 million – 18.14 million) QALYs over this period due to suboptimal control of asthma. In state-level analysis, the average 20-year per-capita costs due to uncontrolled asthma ranged from $2,209 (Arkansas) to $6,132 (Connecticut). Conclusion The burden of uncontrolled asthma will continue to grow for the next twenty years. Strategies towards better management of asthma may be associated with substantial return on investment.