The Economic Burden of Asthma in Greece: A Cross-Sectional Study
The high prevalence rates of asthma worldwide and the chronic nature of the disease make asthma a major cause of morbidity, imposing a significant socio-economic burden in many countries. Specifically in Greece, the self-reported prevalence of asthma reached 9% in 2017.
The objective of this study was to estimate the total management cost of asthma in Greece and its potential determinants.
A population-based, random-digit-dialed telephone nationwide survey was conducted to recruit patients with asthma in Greece (n = 353). A structured questionnaire was used to collect data on demographic and lifestyle characteristics, exacerbations, asthma control, medical resource utilization, and productivity loss during the past 12 months. The total annual direct cost from the societal, payer, and patient perspective as well as the indirect cost was calculated. All costs refer to the year 2017 (€). The significance level was set to α = 0.05.
The mean (95% confidence interval) annual total cost per patient for asthma management from the societal, payer, and patient perspective was €895 (696–1105), €673 (497–861), and €151 (119–188), respectively. The direct medical cost accounted for almost 90% of the total cost, whereas only 4% was attributed to the indirect cost. The direct medical cost was mainly driven by the medication cost (48%). The total annual societal cost was statistically significantly higher in those with not well-controlled asthma (p = 0.014) and those experiencing exacerbations during the past 12 months (p < 0.001) than in their counterparts. The total annual economic burden of asthma in Greece was estimated at €727 million and €547 million from the societal and payer perspective, respectively.
Our findings indicate that asthma imposes a high economic burden on society and the healthcare system in Greece. Therefore, greater investment in interventions aimed at asthma control and prevention of acute exacerbations may reduce the overall burden of asthma in Greece.
K.V. conducted part of the data analysis and wrote the manuscript. G.K. designed the study, conducted part of the analysis, interpreted the results, and wrote part of the manuscript. She also reviewed the manuscript. N.M., P.B., and S.L. contributed in the study design, questionnaire development, results interpretation, and manuscript writing.
Compliance with Ethical Standards
This study was funded by the Hellenic Thoracic Society. The authors would like to thank the Hellenic Thoracic Society for this sponsorship.
Conflict of Interest
The authors, Katerina Vellopoulou, Petros Bakakos, Stelios Loukides, Nikos Maniadakis, and Georgia Kourlaba declare that they have no conflicts of interest related to the content of this study.
Data Availability Statement
The dataset, along with the software code, will be provided upon request.
- 1.Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2014. http://www.ginasthma.org. Accessed Jul 2017.
- 4.ERS. European Respiratory Society. European Lung White Book. 2013. https://www.erswhitebook.org/chapters/. Assessed Jul 2017.
- 8.ERS. European Lung Book 2013. Available from: https://www.ersnet.org/images/stories/pdf/asthma.pdf. Accessed 24 July 2017.
- 13.SEDEA. Society of Opinion and Market Research Companies (Σύλλογος Εταιρειών Δημοσκόπησης και Έρευνας Αγοράς) 2018. http://sedea.gr/.
- 15.Schatz M, Mosen DM, Kosinski M, Vollmer WM, Magid DJ, O’Connor E, et al. Validity of the asthma control test completed at home. Am J Manag Care. 2007;13(12):661–7.Google Scholar
- 17.MoH. Government Gazette issue Β' 2883. Modification of the common ministerial decision numbered .Φ.42000/οικ.2555/353/28−2−2012, (ΦΕΚ497/Β/2012), entitled: List of diseases for which the drugs are dispensed at zero or reduced copayment 2012. Available from: http://www.eof.gr/assets/FEK_2883.pdf. Accessed Apr 2017.
- 18.MoH. Unified Regulation for Health Care Benefits (EKPY) 2015. Available from: http://www.isrodou.gr/images/300915_%CE%9A%CE%95%CE%99%CE%9C%CE%95%CE%9D%CE%9F_%CE%95%CE%9A%CE%A0%CE%A5_docx_%CE%A4%CE%95%CE%9B%CE%99%CE%9A%CE%9F__2_.pdf. Accessed July 2017.
- 19.MoH. Ministerial Decision: Diagnosis Related Groups and Daycare cost in Hellenic National Health System. 2012.Available from: https://www.sfee.gr/wp-content/uploads/2014/11/946.%CE%188.8.131.522.pdf. Accessed April 2017.
- 20.Greek Ministry of Health, M. Drug price bulletin. http://www.moh.gov.gr/articles/times-farmakwn/deltia-timwn/4594-deltio-timwn-newn-farmakwn-anthrwpinhs-xrhshs-13-04-2017. Accessed April 2017.
- 22.MoH. Government Gazette 2315/19-6-2018 2nd issue: Modification and replacement of the common ministerial decision with nr. Φ.90380/25916/3294/31.10.2011 (Β΄ 2011) entitled «Unified Regulation for Health Care Benefits (EKPY) by the National National Organization of Health Care Services Provision (ΕΟPYY)». 2018 [09.2018]. Available from: http://www.ispatras.gr/wp-content/uploads/2018/06/%CE%95%CE%9A%CE%A0%CE%A5-%CE%95%CE%9F%CE%A0%CE%A5%CE%A5-1.pdf.
- 23.International Monetary Fund. World Economic Outlook Database, April 2017. 2017. Available from: http://www.imf.org/external/pubs/ft/weo/2017/01/weodata/weorept.aspx?sy=1980&ey=2022&scsm=1&ssd=1&sort=country&ds=.&br=1&pr1.x=81&pr1.y=8&c=174&s=NGDPRPC%2CNGDPPC&grp=0&a=#download. Accessed July 2017.
- 25.Hellenic Statistical Authority (ELSTAT). Permanent population per age, sex and family status, entire country and peripheries 2011. Available from: https://www.statistics.gr/el/statistics/-/publication/SAM03/-. Accessed Sept 2017.
- 36.Lewis A, Torvinen S, Dekhuijzen PN, Chrystyn H, Watson AT, Blackney M, et al. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Serv Res. 2016;12(16):251. https://doi.org/10.1186/s12913-016-1482-7.CrossRefGoogle Scholar
- 41.Holbrook AL, Green MC, Krosnick JA. Telephone versus face-to-face interviewing of national probability samples with long questionnaires: comparisons of respondent satisficing and social desirability response bias. Public Opin Q. 2003;67(1):79–125. https://doi.org/10.1086/346010.CrossRefGoogle Scholar