Cost And Resource Utilization Of Uncontrolled And Persistent Asthma In Canada: A Systematic Literature Review


      Asthma is a chronic inflammatory airway disease that causes a significant economic and humanistic burden. The objective of this study was to systematically review the evidence on cost and resource utilization in uncontrolled and persistent asthmatic patients in Canada.


      A literature search was performed using keywords such as “asthma”, “hospitalization”, “medical services”, and “cost”. The search was conducted in the MEDLINE, EMBASE and PubMed electronic databases from January 1st 2005 to May 28th, 2015. To be eligible, studies had to be Canadian, focus on uncontrolled or persistent asthma and include cost or resource utilization data.


      The search retrieved 17,335 studies of which 7 fulfilled the eligibility criteria. Among the 7 retrieved studies on uncontrolled or persistent asthma, 6 reported resource utilization data and 3 reported cost data. Among the resource utilization studies, 6 reported data on hospitalizations, 4 on emergency department (ED) visits and 3 on physician visits at a patient-level. The hospitalization rate ranged from 15% to 64.5% per patient per year and the mean hospitalization length of stay was 1.83 days. The rates for ED visits ranged from 3.4% to 50.4% with 2 studies reporting rates over 20%. One study reported a mean physician-visit rate of 50% per patient per year while another study reported that 64.3% of the patients had at least 4 physician-visits per year. In the cost studies, the total mean direct cost in adjusted 2015CDN$ per patient per year ranged from $413 to $1,764, carrying overall additional cost for uncontrolled asthma to nearly $189 million annually in Canada.


      This analysis indicates that uncontrolled and persistent asthma is associated with considerable cost and resource use, especially regarding hospitalizations, ED visits and physician visits at a patient-level, thus leading to an important economic burden at a population-level in Canada.