Beyond direct costs: Individual and societal burden of asthma in young adults

Abstract

<b>Introduction:</b> Asthma is a known driver of societal cost, yet many studies tend to focus solely on the direct costs or utilize select, smaller populations. Therefore, we aim to assess the total, nationwide economic burden of asthma from both an individual and a societal perspective. <b>Methods:</b> The annual cost of asthma in Denmark was predicted in a nationwide cohort of patients aged 18-45 during 2014-16 as excess healthcare costs, loss of income and welfare expenditure compared to controls (matched 1:4 by age, sex, marital status, and residence) using national registries. Asthma severity was defined as mild-to-moderate (Steps 1-3 or Step 4 without exacerbations) or severe (Step 4 with exacerbations or Step 5) according to the GINA 2020 guidelines. <b>Results:</b> Across 63,130 patients (mean age 33, 55% female), the annual cost of asthma was predicted to € 4,095 per patient. Beyond direct costs related to treatment and hospitalizations (€ 1,555), the majority of financial burden was driven by indirect costs related to loss of income (€ 1,060) and welfare expenditure (e.g., social security and disability pensions) (€ 1,480). When stratified according to severity, patients with severe asthma (4.5%) incurred 4.4 times higher net costs (€ 15,749) than those with mild-to-moderate disease (€ 3,587). Exacerbations were a large contributor to direct severe asthma costs, with direct costs ranging from € 961 to € 1,700 per moderate and severe exacerbation, respectively. <b>Conclusion:</b> In young adults with asthma, a significant financial burden of disease was seen across severities. Expenditure was driven by loss of income and welfare utilization, rather than direct healthcare costs.