Global and regional projections of the economic burden of Asthma: a value of statistical life approach

Introduction

Advancements in medicine, public health, and societal standards have notably elongated the global lifespan.¹ Globally, life expectancy has increased by more than 6 years between 2000 and 2019 – from 66.8 years in 2000 to 73.4 years in 2019.² In parallel, the prevalence of Asthma, a chronic respiratory ailment primarily afflicting the airways, has exhibited an upward trend, and is anticipated to continue its ascent. the Global Burden of Disease Study (GBD) estimated that in 2019, there were 262 million people affected by asthma, equating to an age-standardised rate of 3416 cases per 100,000 population.³ Asthma poses challenges to individual health, with manifestations often commencing in childhood yet persisting into adulthood, culminating in significant morbidity and mortality. Despite its status as a prevalent chronic ailment, asthma remains underdiagnosed and inadequately treated across many regions. It is associated with recurrent exacerbations, compromised pulmonary function, and diminished quality of life. In 2019, Asthma accounted for approximately 21.55 million disability-adjusted life years (DALYs) globally, underscoring its substantial toll on public health.³

Asthma management involves ongoing medical care, including diagnostic testing, medications (such as inhaled corticosteroids and bronchodilators), emergency care for acute exacerbations, and regular monitoring. These requirements translate to significant healthcare costs, both direct (medical expenses) and indirect (such as lost productivity due to absenteeism). The economic burden of Asthma encompasses diverse direct and indirect expenditures, spanning healthcare outlays, productivity losses, and diminished quality of life.⁴ In the USA, during the 2008–2013 period, asthma was responsible for $50.3 billion in medical costs and $29 billion due to asthma-related mortality,⁵ and the forecast both in the USA and in various European countries, China and Brazil is that this cost will continue to grow in tandem with population aging.^6–10 Additionally, indirect costs stemming from absenteeism, presenteeism, and disability further strain healthcare systems and economies globally. Projections help policymakers and healthcare providers plan for adequate resource allocation. Efforts to quantify the global economic burden of Asthma are pivotal for informing healthcare policies, resource allocation, and investment in research and development. By understanding the economic burden and its projections, public health officials and governments can design more effective asthma management and prevention strategies. This might include targeted interventions in high-burden areas, improving access to care, and addressing environmental factors contributing to asthma prevalence.

In summary, Asthma presents a substantial public health quandary with profound social and economic ramifications. Through accurate assessment of its economic repercussions, policymakers and healthcare stakeholders can implement targeted interventions to mitigate the impact of asthma on individuals, communities, and healthcare systems worldwide. This study aimed to estimate the global economic burden of asthma.

Methods

Results

The Table 1 delineates the projected economic burden of asthma across different country income groups from 2023 to 2050, expressed in millions of 2020 constant US dollars. The data reveal a stark disparity between high-income countries (HICs) and low- and middle-income countries (LMICs). For instance, the economic burden in low-income countries is expected to increase from 1,090 million dollars in 2023 to 1,265 million dollars in 2050, reflecting both population growth and increased prevalence of asthma. Meanwhile, high-income countries face a much higher burden, with costs rising from 130,290 million dollars in 2023 to 133,370 million dollars in 2050. These projections underscore the disproportionate impact of asthma on wealthier nations, despite their more advanced healthcare systems.

The global economic burden of asthma is projected to rise from 1,413,210 million dollars in 2023 to 1,555,276 million dollars by 2050. This escalation highlights the increasing strain asthma places on global economies, necessitating improved management and prevention strategies. The projections are based on constant growth rates from 2010 to 2021 and adjusted to 2023 constant US dollars using consumer price index data. The significant rise in costs, particularly in LMICs, emphasizes the need for international collaboration and investment in healthcare infrastructure to mitigate the economic impacts of asthma. Figure 1 illustrates the estimated per capita economic burden of asthma by country through 2023, measured in millions of of 2020 US dollars. The visualization starkly highlights the global disparity in asthma-related costs, with higher burdens concentrated in developed nations. Countries with significant economic burdens, such as the United States and Australia, are clearly demarcated, showcasing the substantial healthcare costs they bear. This figure serves as a critical reminder of the need for targeted asthma management strategies, especially in nations facing high per capita costs.

Figure 1. Estimated per capita economic burden of asthma by country through 2023, millions 2020 US$.

Table 2a, 2b and 2c (Extended data) offers a detailed country-by-country breakdown of the projected economic burden of asthma from 2023 to 2050, expressed in millions of 2023 constant US dollars. For example, Afghanistan’s economic burden is projected to rise dramatically from 846,689 million dollars in 2023 to 995,844 million dollars in 2050, reflecting the country’s growing healthcare challenges. Similarly, Algeria’s burden increases from 86,605 million dollars in 2023 to 116,539 million dollars in 2050, illustrating the broader trend of escalating healthcare costs in many nations. These projections, derived from data covering over 99% of the global population, are adjusted using the U.S. consumer price index and discounted at a 3% annual rate. The figures include 95% uncertainty bounds, indicating a range of possible outcomes and reflecting the inherent unpredictability in long-term economic forecasting. For instance, Australia’s estimated burden in 2023 ranges from 901,483 to 2,079,529 million dollars, highlighting potential variations due to economic and healthcare factors. This data underscores the urgent need for robust, adaptable healthcare policies and international support to manage the rising economic impact of asthma effectively. Figure 2 depicts the estimated percentage change in the per capita economic burden of asthma by country through 2050, expressed in millions of of 2020 US dollars. This figure vividly demonstrates the anticipated growth in asthma-related costs over the coming decades, with many countries, particularly in low- and middle-income regions, expected to see significant increases. For instance, several African and Asian nations are projected to experience substantial percentage growth in per capita costs, highlighting the pressing need for improved asthma care and prevention strategies in these areas.

Figure 2. a: Estimated percentage of change of per capita economic burden of asthma by country through 2030. b Estimated percentage of change of per capita economic burden of asthma by country through 2040. c. Estimated percentage of change of per capita economic burden of asthma by country through 2050.

The data, covering 168 countries and over 99% of the world’s population, are projected based on a constant growth rate from 2010 to 2021 and adjusted to 2023 constant US dollars using U.S. consumer price index data. This comprehensive coverage and methodological rigor lend credibility to the projections, emphasizing the widespread and growing financial impact of asthma. The figure’s clear visual representation aids policymakers and healthcare professionals in identifying priority areas for intervention to reduce the economic burden of asthma.

Discussion

Our study shows that the economic impact of asthma is projected to increase significantly globally, with a greater growth in low- and middle-income countries compared to high-income countries. Our results show a consistent rise in the economic burden of asthma from 2023 to 2050, both in absolute terms and per capita. This information is crucial for global decision-making as it highlights the urgent need to invest in asthma prevention and management strategies, especially in regions with accelerating cost growth. Furthermore, it underscores the importance of international collaboration and resource allocation to mitigate the financial and health impacts of asthma, ensuring that healthcare systems can effectively and equitably address this challenge.

Yaghoubi et al. assess the future health and economic impact of uncontrolled asthma in adolescents and adults in the U.S. over the next two decades.²⁰ hrough a probabilistic model that integrates state-specific projections for population growth, aging, asthma prevalence, and control levels, the study estimates that uncontrolled asthma will result in direct healthcare costs of $300.6 billion. When factoring in indirect costs, the total economic burden rises to $963.5 billion. The model also predicts a loss of 15.46 million quality-adjusted life years (QALYs) due to poor asthma control. The projected per capita costs vary widely across states, from $2,209 in Arkansas to $6,132 in Connecticut. The study emphasizes the significant and growing burden of uncontrolled asthma but suggests that improving adherence to asthma management guidelines could substantially reduce costs and improve patient outcomes.

Similarly, Accordini et al. examined the real-world economic costs associated with persistent asthma in European adults, based on the level of asthma control as defined by the 2006 Global Initiative for Asthma (GINA) guidelines.²¹ This cost-of-illness analysis, which included 462 adults aged 30-54 from 11 European countries, was conducted using data from the European Community Respiratory Health Survey II (1999-2002). Adjusted to 2010 values, the study found that the average total cost per patient was EUR 1,583, largely driven by indirect costs such as lost workdays and reduced daily activity (62.5%). The estimated economic burden for the 30-54 age group in these countries was EUR 4.3 billion, rising to EUR 19.3 billion for the 15-64 age group across Europe. Costs varied significantly, with controlled asthma patients incurring EUR 509 annually, compared to EUR 2,281 for those with uncontrolled asthma. Factors such as chronic cough, excessive mucus production, and high BMI were associated with higher costs. The study concludes that enhancing asthma management in adults could generate significant cost savings.

Lai et al. explored the economic burden of asthma in eight countries within the Asia-Pacific region by analyzing survey data on resource utilization by individuals with asthma.²² The study calculated the direct and societal costs of asthma per patient by obtaining unit costs for various healthcare resources. Annual direct healthcare costs ranged from US$108 in Malaysia to US$1,010 in Hong Kong, while total societal costs, including productivity losses, ranged from US$184 in Vietnam to US$1,189 in Hong Kong. Urgent care services accounted for 18-90% of total direct costs per patient. The study highlighted that per-patient costs represented a significant portion of per capita gross domestic product (GDP) and healthcare expenditure, suggesting that improved asthma control could reduce these costs and lead to better health outcomes.

The studies by Yaghoubi et al., Accordini et al., and Lai et al. focus on predicting and evaluating the economic burden of asthma in different regions, but they differ in methodology and scope. Yaghoubi et al. use a probabilistic model to predict the future health and economic burden of uncontrolled asthma in American adolescents and adults over 20 years, in contrast, Accordini et al. conduct a real-world prevalence-based cost-of-illness study among European adults, calculating mean total costs per patient and highlighting the impact of disease control levels and Lai et al. analyze the burden of asthma in eight Asia-Pacific countries using survey responses on resource use. Utilizing the Value of a Statistical Life Year (VSLY) to estimate the value of a year of life lost to asthma offers several advantages over other methods such as probabilistic models, real-world prevalence-based cost-of-illness studies, or survey responses on resource use. VSLY provides a standardized monetary valuation of the benefits associated with reducing mortality risks, enabling a more direct comparison of health outcomes across different studies and interventions. This approach captures the broader societal willingness to pay for a year of healthy life, reflecting both the economic and intrinsic value of life extension. In contrast, probabilistic models focus on predicting future burdens with inherent uncertainties, cost-of-illness studies primarily address direct and indirect costs without fully integrating the societal perspective on life value, and survey-based analyses often depend on self-reported data that can be subject to bias and variability. Thus, VSLY offers a comprehensive and consistent framework for evaluating the economic impact of asthma, facilitating better-informed policy decisions and resource allocation aimed at improving public health outcomes.

Our results reveal the substantial and escalating global economic burden of asthma. Lower-middle-income countries will experience the highest costs, reflecting both high prevalence and growing healthcare needs. Also, we show the significant variations in economic impact, with countries like China and India bearing enormous future costs due to their large populations and increasing asthma cases. In general, there are a rising per capita economic burden and the percentage increase in costs through 2050. These findings imply that without effective intervention, the global cost of asthma will continue to soar, driven by factors such as population growth, aging, and inadequate disease control. Key challenges include improving access to asthma management and treatment in low and middle-income countries, addressing environmental factors contributing to asthma, and enhancing public health policies to promote preventive care. To reduce future global costs, it is imperative to invest in widespread education on asthma management, bolster healthcare infrastructure, and implement policies that target the root causes of asthma exacerbations. Collaborative international efforts and sustained commitment from governments, healthcare providers, and communities are crucial to mitigating the economic impact and improving the quality of life for those affected by asthma.

Our study has limitations. The main limitation of using the Value of a Statistical Life Year (VSLY) to estimate the value of a year of life lost to asthma worldwide is the significant variation in economic conditions, healthcare systems, and cultural perceptions of health across different countries. VSLY typically reflects the willingness to pay for risk reductions in high-income countries, where the economic capacity and health priorities differ markedly from those in low and middle-income countries. This disparity can lead to skewed valuations that do not accurately represent the true economic and social impact of asthma in less affluent regions. Additionally, VSLY may not adequately capture the heterogeneity in life expectancy, quality of life, and access to healthcare services globally. As a result, relying solely on VSLY for global estimates can oversimplify complex, context-specific issues, potentially leading to misinformed policy decisions and resource allocation that fail to address the unique needs and challenges of diverse populations. Despite the limitations of using the Value of a Statistical Life Year (VSLY) to estimate the value of a year of life lost to asthma, these limitations may not significantly affect the results obtained in our study The data in these tables and figures are based on a range of economic and health indicators that account for differences in income levels, healthcare spending, and demographic trends across countries. By using constant US dollars and adjusting for factors such as inflation and population growth, the projections provide a standardized view of the economic burden of asthma globally. Additionally, the inclusion of a wide range of countries and the use of income elasticity values help to balance the disparities between high-income and low- and middle-income countries. This comprehensive approach ensures that the overall trends and projections remain robust, offering valuable insights into the future economic impact of asthma. Therefore, while VSLY limitations highlight the need for caution in interpreting specific monetary values, the broader patterns and implications of the data remain valid and crucial for informing global health policies and interventions.

In conclusion, our study reveal that the economic impact of asthma is projected to increase significantly globally, with a greater growth in low- and middle-income countries compared to high-income countries. Our results show a consistent rise in the economic burden of asthma from 2023 to 2050, both in absolute terms and per capita.