Az asthmas betegek tuneteinek onertekelese az orvosi GINA-osztalyozas tukreben es az asthma bronchiale tarsadalmi koltsegvonzata (HUNAIR vizsgalat)

Translated title of the contribution: Disparity in the perception of the disease in asthmatics and their pulmonologists plus resource consumption of asthmatics in Hungary (HUNAIR Study)

P. Magyar, K. Gyurkovits, I. Herjavecz, G. Boszormenyi Nagy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

INTRODUCTION - Bronchial asthma is a chronic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (HUNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asthmatic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self- assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric centres in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asthma. An approximate 'one third' rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost workdays, 1/3 by drug costs and 1/3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics, 1/3 by emergency medicines and 1/3 by other medicines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and 1/3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's self-assessment; 2. the source utilisation was twice as high in asthmatic children as adults; 3. the resource utilisation was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - It can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost- effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which consider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.

Original languageHungarian
Pages (from-to)292-307
Number of pages16
JournalLege Artis Medicinae
Volume10
Issue number4
Publication statusPublished - 2000

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Hungary
Costs and Cost Analysis
Drug Costs
Asthma
Physicians
Pediatrics
Pulmonologists
Cost-Benefit Analysis
Steroids
Patient Acceptance of Health Care
Anti-Asthmatic Agents
Emergency Medicine
Health Resources
Respiratory Function Tests
Developed Countries
Hospitalization
Emergencies
Chronic Disease

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Az asthmas betegek tuneteinek onertekelese az orvosi GINA-osztalyozas tukreben es az asthma bronchiale tarsadalmi koltsegvonzata (HUNAIR vizsgalat). / Magyar, P.; Gyurkovits, K.; Herjavecz, I.; Boszormenyi Nagy, G.

In: Lege Artis Medicinae, Vol. 10, No. 4, 2000, p. 292-307.

Research output: Contribution to journalArticle

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AU - Magyar, P.

AU - Gyurkovits, K.

AU - Herjavecz, I.

AU - Boszormenyi Nagy, G.

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N2 - INTRODUCTION - Bronchial asthma is a chronic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (HUNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asthmatic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self- assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric centres in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asthma. An approximate 'one third' rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost workdays, 1/3 by drug costs and 1/3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics, 1/3 by emergency medicines and 1/3 by other medicines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and 1/3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's self-assessment; 2. the source utilisation was twice as high in asthmatic children as adults; 3. the resource utilisation was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - It can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost- effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which consider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.

AB - INTRODUCTION - Bronchial asthma is a chronic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (HUNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asthmatic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self- assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric centres in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asthma. An approximate 'one third' rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost workdays, 1/3 by drug costs and 1/3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics, 1/3 by emergency medicines and 1/3 by other medicines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and 1/3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's self-assessment; 2. the source utilisation was twice as high in asthmatic children as adults; 3. the resource utilisation was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - It can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost- effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which consider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.

KW - Assessment of symptoms

KW - Asthma

KW - Drug costs

KW - GINA classification

KW - Limitations of activity

KW - Self-assessment of patients

KW - Societal costs

KW - Treatment costs

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