Prevention Makes Common "Cents". Asthma

09/01/2003

Asthma is an obstructive lung disease caused by an inflammatory reaction and hyperreactivity of the airways to various triggers. Inflammation and bronchospasm of the airways restricts airflow into and out of the lungs. Asthma is characterized by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing. In sensitive individuals, asthma symptoms can be triggered by inhaled allergens (allergy triggers), such as pet dander, dust mites, cockroach allergens, molds, or pollens. Symptoms of asthma can also be triggered by respiratory

Northeast Utilities

The goal of Northeast Utilities' WellAware program is to improve the health and well-being of employees and families through participation in targeted programs and services that address lifestyle-related health risks; and to reduce health care costs. Northeast Utilities found that almost 17% of its health care claims were attributable to modifiable, lifestyle behaviors. Key features of the program include: financial incentives for participation, employees and spouses eligible, strong senior management support, and ongoing evaluation and re-design.

The components of the program include: a health risk assessment which is the "ticket" into program, a telephonic high risk intervention, a secondary coronary artery disease management program, telephonic smoking cessation counseling and rebate for purchasing smoking cessation aids, integration with internal departments (health units, safety, EAP) and external partners (health plans, local hospitals, etc.), accessible via on-site programs, communication of community programs, guidebooks, videos, and telephonic intervention programs, Internet site allows access at work and home, and a toll free hotline for materials and questions.

In its first 24 months, Northeast Utilities documented a 1.6 return on investment from the WellAware program, including a $1,400,000 reduction in lifestyle and behavioral claims and flat per capita costs for health care. Participants in the program demonstrated a reduction in health risk factors including a 31% decrease in smoking, a 29% decrease in lack of exercise, a 16% decrease in mental health risk, a 11% decrease in cholesterol risk, an 10% improvement in eating habits, and a 5% decrease in stress.

To contact Northeast Utilities for more detailed information, see: www.nu.com.

Pfizer

Pfizer employs 35,000 in the U.S., including Puerto Rico. The goals of Pfizer's Employee Health and Wellness stategy are to assist Pfizer to attract and retain best people; increase productivity; enhance employee and dependent health by primary, secondary, tertiary prevention; effectively manage health care resources; and help employees and dependents be informed and efficient health care consumers. Pfizer's Employee Health and Wellness strategy is a multi-dimensional, highly integrated approach with on-site administration and access. It includes: health risk assessment/identification initiatives, wellness and health education initiatives, disease management initiatives, medical clinics, fitness centers, on-site physical therapy, a ergonomics program, managed disability program, welfare benefits/health care delivery evaluation/enhancement intiatives, and an Employee Assistance Program.

In Pfizer's New York location, 85% of employees participate in one or more programs, and 80% of employees use on-site health services. Over 41% (1,850 members) of the total population participates in the fitness center at this site, with waiting list of 250 for enrollment. The Premier Employer Program is promoted via communication and education to employees delivered via a variety of media. Print materials, on-site communication, and intranet/internet access to information on the health management program ensures that employees have access to information regarding program initiatives. These media also provide up-to-date information on health risk reduction. New initiatives are added as needs are reassessed and program effectiveness evaluated. Pfizer's research staff measures the impact of initiatives and analyzes the cost-effectiveness and return on investment.

Pfizer's ergonomics program demonstrated a return on investment (ROI) of 3.51 to 1 and a net savings of $1,153,206 for participants. The physical therapy program generated an average ROI of 3.61 to 1 (2001), and produced over $579,000 in savings related to employee lost time avoided by on-site access to services. In 1998, the ROI for the fitness centers program was 4.29 to 1.

To contact Pfizer for more detailed information, see: www.Pfizer.com

infections, exercise, cold air, tobacco smoke and other pollutants, stress, food, or drug allergies. Currently, asthma is the 6th-ranking chronic condition among the general American population in terms of prevalence and the leading serious chronic illness of children in the U.S.

The Prevalence of Asthma

Three metrics are used to describe asthma prevalence:

  • Lifetime prevalence, which indicates how many individuals in the population have been diagnosed with asthma at least once in his or her lifetime
  • Current prevalence, which indicates how many individuals in the population are currently diagnosed with asthma in a given year
  • Attack prevalence, which indicates how many individuals in the population have had an asthma attack in a given year

The most recent data available, from 2001, show a lifetime prevalence rate of 113.4 per 1000 persons for the overall United States population. Approximately 22.2 - 23.2 million adults and 9.1 million children have been diagnosed with asthma at some point within their lifetime, giving a composite estimate of about 31.3 - 32.3 million Americans who have had or currently have asthma. Recently, children (ages 5-17) have displayed the highest lifetime prevalence rates; in 2001, the lifetime prevalence rate was 144.2 per 1000 children. Females have a 10 percent higher lifetime prevalence rate than males.(107)

The current prevalence rate for 2001--the ratio of the U.S. population who actually had asthma during that year--was estimated to be 73.4 per 1000 persons, or about 20.3 million Americans. The highest current prevalence was observed in those 5-17 years of age at a rate of 98.1 per 1000 persons. The current prevalence rate in females, at 82.6 per 1000 persons, was 30 percent higher than that for males, at 63.6 per 1000 persons. This pattern was reversed in children: the current asthma prevalence rate for boys was 30 percent higher than for girls (ages 0-17).(108)

Prevalence of Asthma By Gender, 2001
Age/Gender Category Asthma Prevalence Rate, 2001 (per 1000 population)
Girls, ages 0-17 74.4
Boys, ages 0-17 99.0
All Females 82.6
All Males 63.6
Overall 73.4
 



Source: Trends in Asthma Morbidity and Mortality. American Lung Association Epidemiology & Statistics Unit. March 2003.

Within the population suffering from asthma in 2001, approximately 12 million Americans had an asthma attack; of this number, about 4 million were children under 18. The overall asthma attack rate in the general population was 43.4 per 1000 persons in 2001.(109)

Reliable statistical data on asthma prevalence are available from the year 1980 forward. From 1980 to 1996, the number of Americans afflicted with asthma doubled to 15 million, with children under five years of age experiencing the highest rate of increase.(110) Children (ages 5-17) have had the highest prevalence rates between 1997 and 2001, demonstrating that the asthma epidemic will continue to be a significant health problem for future generations.(111)

The Costs of Asthma

The costs of asthma have increased in step with the rise in asthma prevalence. The first comprehensive economic evaluation of asthma in 1992 estimated the total cost of the disease to be $6.2 billion per year.(112) A study on the national costs of asthma for the year 1997 estimated those costs at $8 billion-$11 billion.(113) The National Heart, Lung, and Blood Institute within the National Institutes of Health estimated that the annual costs of asthma were $11.3 billion per year in 1998. The two most recent analyses of the economic impact of asthma, commissioned by the American Lung Association (ALA) to study asthma costs in 2000 and 2001, cited annual estimates of $12.7 billion and $14 billion, respectively.(114)

figure 7. Total Cost of Asthma

Figure 7. Source of data: NIH/NHLB; Refs. 112, 114.

The ALA study of asthma costs in 2001 evaluated both direct health care costs of asthma (hospital care, physicians' services, and medications) and indirect costs of lost productivity (school days lost, work days lost, and lifetime earnings lost due to mortality). In 2002 dollars, these cost categories totaled $9.4 billion and $4.6 billion, respectively. Direct medical care costs covered approximately 465,000 hospitalizations, 1 million hospital outpatient department visits, 1.8 million emergency room visits, and 10.4 million physician office visits due to asthma each year.(115) About 1 in 6 pediatric emergency room visits is caused by an asthma attack.(116), (117) Indirect costs encompass about 14 million lost school days, 14.5 million lost work days, and the productivity loss of the approximately 5,000 people who die from asthma each year. Asthma is the most common reason for school absence--this specific indirect cost alone results in an estimated $1 billion annual productivity loss.(118)

The financial burden of asthma is borne heavily by patients and their families. Out-of-pocket expenses for asthma are estimated at roughly 25 percent of total medical costs compared to the average of 10 percent for medical expenses for all illnesses.(119) The average family in the U.S. spends between 5.5 percent and 14.5 percent of its total income on treating an asthmatic child.(120) However, employers are not impervious to this cost burden. Annual per capita employer expenditures for asthmatic patients were approximately 2.5 times those for control subjects ($5,385/employee versus $2,121/employee). For asthmatic employees, wage-replacement costs for workdays lost as a result of disability and absenteeism accounted for almost as much as did medical care (40 percent versus 43 percent).(121)

As indicated above, both prevalence and costs of asthma have increased markedly over the past decade and a half. While there is no consensus as to why asthma prevalence has increased, scientists studying the phenomenon have postulated that obesity and lack of physical exercise, dietary changes, and increased exposure to indoor allergens are among the reasons for the increase.(122) The growth in costs of asthma is largely due to the increase in asthma prevalence: prevalence rates increased by nearly 70 percent from 1986 to 1996, far outpacing the 12 percent growth in population. Average costs for asthma per capita actually decreased over this period, despite the significant increase in absolute costs.(123) That is, while treatments have become more cost-effective, total costs have still ballooned because of the greater proportion of the population with asthma. This indicates that, in order to contain asthma costs in the future, better treatments must be supplemented with prevention strategies aimed at reducing asthma prevalence.

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