Costs and social impact of Asthma
Asthma prevalence and incidence have been increasing worldwide in recent decades. This increase is not only attributable to genetic background but largely because of the effect of a wide number of environmental and lifestyle risk factors. Unfortunately, in many countries, asthma and other non-communicable diseases are yet to be considered a healthcare priority.
In Nigeria, more than 15m people are currently suffering from asthma with a projected increase to 100m in year 2025. Globally, more than 300m people are currently with asthma and this is expected to increase by over 100m in year 2015.
It is also estimated that 14 per cent and 8.6 per cent of the world’s children and young adults’ experience asthma symptoms, while 4.5per cent of young adults have been diagnosed with asthma and/or are taking treatment for asthma.
The burden of asthma is greatest for children aged 10-14 and the elderly aged 75-79. Currently, Asthma is the 14th most important disorder in the world in terms of the extent and duration of disability. Given the well-known under-diagnosis of asthma, the above quoted numbers may be an underestimation.
As a globalized and significant public health problem, which oftentimes, requires use of emergency care, hospital admission and can cause early permanent disability and premature death, asthma requires urgent policy and government attention to enhance the management of asthma in Nigeria.
Asthma management comes with very huge costs. These costs are direct, indirect and intangible costs.
Direct cost include cost of asthma management (visits to emergency services; hospital admissions; medications, including all types of medications, such as over-the counter and alternative medicines; outpatient visits, including all human resources involved, such as doctors, nurses, paramedics, psychologists), complementary investigations or treatments (imaging, skin and blood tests, lung function tests, pulmonary rehabilitation) and other costs (domestic or professional preventive measures, assistance in home care, transportation to medical visits, burial costs).
On the other hand, indirect costs include work-related losses (temporary disability in terms of partial or total lost-days; early disability; permanent disability,) and early mortality and finally, intangible costs are those related with unquantifiable losses, such as the decrease in quality of life, increases in pain or suffering, limitation of physical activities and job changes.
Asthma costs USA economy more than US$ 80 billion annually in medical expenses, days missed from work and school, and deaths.
The recent data from the USA indicates that medical expenditures attributable to asthma were significantly higher for those with markers of uncontrolled disease when compared with medical expenditures of those who did not have asthma. The above cost is more than thrice the Nigeria’s 2018 budget.
In Nigeria, asthma care imposes economic burden on affected patients; though, patients’ costs for asthma is not well documented in Nigeria and other African countries.
Notwithstanding the above weakness, in a cross-sectional study conducted in three tertiary hospitals in Nigeria by Cajetan Onyedum in 2014, it was found that the annual out-of-pocket cost of asthma incurred by patients in Nigeria was US$368.4 per patient. Medication cost accounted for the majority (87 per cent) of this cost.
This cost does not include other direct, indirect and intangible costs and is not related to costs incurred by patients with exacerbation and differing severity of the disease. This shows that in Nigeria, the annual average out-of-pocket costs incurred my asthma patients is US$ 5.5 billion (N2trillion).
It is therefore important for Nigerian government, in addition to making asthma a health priority, should invest in asthma research, develop national strategies and guidelines and action plan to improve asthma management and reduce costs.
As a Foundation, the Amaka Chiwuike-Uba Foundation (ACUF) is working to carryout baseline study to determine the costs and social impact of asthma in Nigeria. It is our hope that other institutions would collaborate with the Foundation to conduct this survey as soon as the survey instruments are ready.
Chiwuike Uba