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A 10 year asthma programme in Finland: major change for the better.

https://arctichealth.org/en/permalink/ahliterature168103
Source
Thorax. 2006 Aug;61(8):663-70
Publication Type
Article
Date
Aug-2006
Author
T. Haahtela
L E Tuomisto
A. Pietinalho
T. Klaukka
M. Erhola
M. Kaila
M M Nieminen
E. Kontula
L A Laitinen
Author Affiliation
Skin and Allergy Hospital, Helsinki University Central Hospital, P O Box 160, FIN-00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2006 Aug;61(8):663-70
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - economics - epidemiology - therapy
Child
Communication
Cost of Illness
Disabled Persons
Emergency Treatment - statistics & numerical data
Finland - epidemiology
Health Promotion - economics - organization & administration - trends
Hospitalization - statistics & numerical data
Humans
Incidence
Insurance, Disability - economics
Interprofessional Relations
National Health Programs - economics - trends
Pharmaceutical Services - standards
Primary Health Care
Program Evaluation
Smoking - epidemiology
Abstract
A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.
The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.
The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).
It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.
Notes
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PubMed ID
16877690 View in PubMed
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The burden of illness experienced by young children associated with asthma: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature158914
Source
J Asthma. 2008 Jan-Feb;45(1):45-9
Publication Type
Article
Author
Teresa To
Sharon Dell
Paul Dick
Lisa Cicutto
Author Affiliation
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. teresa.to@sickkids.ca
Source
J Asthma. 2008 Jan-Feb;45(1):45-9
Language
English
Publication Type
Article
Keywords
Asthma - economics - epidemiology - therapy
Child
Child, Preschool
Cohort Studies
Cost of Illness
Delivery of Health Care - economics - utilization
Health Care Costs
Hospitalization - economics - statistics & numerical data
Humans
Infant
Ontario
Seasons
Abstract
Using Ontario healthcare administrative databases, over 228,000 children aged 0 to 9 years were identified as having asthma between 1994 and 1998 and followed until they turned 10 years old or the end of the study. The prevalence of childhood asthma increased by 35% during the study period. These children had a higher healthcare utilization and cost over $100 more per child per year than the general population, and contributed to over one third of the total Ontario Health Insurance Plan expenditures. Findings of this study revealed an enormous burden of illness to children with asthma and the healthcare system.
PubMed ID
18259995 View in PubMed
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The Finnish experience to save asthma costs by improving care in 1987-2013.

https://arctichealth.org/en/permalink/ahliterature284740
Source
J Allergy Clin Immunol. 2017 Feb;139(2):408-414.e2
Publication Type
Article
Date
Feb-2017
Author
Tari Haahtela
Fredrik Herse
Jussi Karjalainen
Timo Klaukka
Miika Linna
Riikka-Leena Leskelä
Olof Selroos
Eeva Reissell
Source
J Allergy Clin Immunol. 2017 Feb;139(2):408-414.e2
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Asthma - economics - epidemiology - therapy
Costs and Cost Analysis
Delivery of Health Care
Finland - epidemiology
Humans
National Health Programs
Registries
Reimbursement Mechanisms
Abstract
The Finnish National Asthma Program 1994-2004 markedly improved asthma care in the 1990s. We evaluated the changes in costs during 26 years from 1987 to 2013. Direct and indirect costs were calculated by using data from national registries. Costs from both the societal and patient perspectives were included. The costs were based on patients with persistent, physician-diagnosed asthma verified by lung function measurements. We constructed minimum and maximum scenarios to assess the effect of improved asthma care on total costs. The number of patients with persistent asthma in the national drug reimbursement register increased from 83,000 to 247,583. Improved asthma control reduced health care use and disability, resulting in major cost savings. Despite a 3-fold increase in patients, the total costs decreased by 14%, from €222 million to €191 million. Costs for medication and primary care visits increased, but overall annual costs per patient decreased by 72%, from €2656 to €749. The theoretical total cost savings for 2013, comparing actual with predicted costs, were between €120 and €475 million, depending on the scenario used. The Finnish Asthma Program resulted in significant cost savings at both the societal and patient levels during a 26-year period.
PubMed ID
27979429 View in PubMed
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Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids - a Swedish observational cohort study (PACEHR).

https://arctichealth.org/en/permalink/ahliterature297711
Source
Respir Res. 2018 Sep 03; 19(1):168
Publication Type
Journal Article
Observational Study
Date
Sep-03-2018
Author
Christer Janson
Karin Lisspers
Björn Ställberg
Gunnar Johansson
Gunilla Telg
Marcus Thuresson
Helene Nordahl Christensen
Kjell Larsson
Author Affiliation
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, 751 85, Uppsala, Sweden. christer.janson@medsci.uu.se.
Source
Respir Res. 2018 Sep 03; 19(1):168
Date
Sep-03-2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Administration, Oral
Adrenal Cortex Hormones - administration & dosage
Adult
Aged
Asthma - economics - epidemiology - therapy
Cohort Studies
Female
Follow-Up Studies
Health Care Costs - trends
Humans
Male
Middle Aged
Patient Acceptance of Health Care
Sweden - epidemiology
Treatment Outcome
Abstract
Patients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients.
Primary care medical records data were linked to data from Swedish national health registries. Patients =18 years with a drug claim for obstructive pulmonary diseases during 2007-2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months' post index period: regular OCS equals =5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated.
A total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10-12% of the total cost in all three groups.
In this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.
PubMed ID
30176850 View in PubMed
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Income level and asthma prevalence and care patterns.

https://arctichealth.org/en/permalink/ahliterature209153
Source
Am J Respir Crit Care Med. 1997 Mar;155(3):1060-5
Publication Type
Article
Date
Mar-1997
Author
D. Erzen
K C Carriere
N. Dik
C. Mustard
L L Roos
J. Manfreda
N R Anthonisen
Author Affiliation
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Source
Am J Respir Crit Care Med. 1997 Mar;155(3):1060-5
Date
Mar-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Airway Obstruction - economics - epidemiology
Asthma - economics - epidemiology - therapy
Bronchitis - economics - epidemiology
Child
Child, Preschool
Continuity of Patient Care - economics
Delivery of Health Care - statistics & numerical data
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Income - statistics & numerical data
Infant
Manitoba - epidemiology
Prevalence
Referral and Consultation - statistics & numerical data
Abstract
Manitoba has a universally accessible health-care system that records physician contacts and hospitalizations in such a way that they can be ascribed to individuals. We examined the prevalence of physician-diagnosed asthma, bronchitis, and airways obstruction (total respiratory morbidity [TRM]) in Winnipeg in 1988 and 1992, using place of residence to divide people into quintiles according to average family income. Physician office visits, hospitalizations, and consultation referrals were each examined. Three age groups: 0 to 14 yr, 15 to 34 yr, and > or = 35 yr were studied. The prevalence of TRM was greater in low- than in high-income quintiles. Asthma prevalence was unrelated to income in the younger age groups; in the older group asthma was more common in low-income groups, but was less strongly related to income than was TRM. Asthma prevalence increased over the years studied, but the increase was not related to income level. There was some evidence of income-related diagnostic bias in that low-income patients were more likely to be labeled with a related diagnosis in addition to asthma than were high-income patients. Low-income patients had more physician contacts than did high-income patients. In terms of physician office visits, care continuity did not differ among income quintiles. Low-income quintiles had more hospitalizations than did high-income quintiles, and differences were larger than could be accounted for by diagnostic bias; asthma was probably more severe in low-income quintiles. High-income quintiles had more consultation referrals than did low-income quintiles.
PubMed ID
9116987 View in PubMed
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