Analysing the economy: asthma is changing Analizando la economía, algo está cambiando en el asma

The current global economic crisis has also affected health professionals. The economic impact, therefore, that diseases have on society is an issue of paramount importance. Currently, these communal health aspects go beyond the actual health systems, for instance, the upcoming political debate concerning the financial cost assumed by society for the social welfare state, specifically that of universal health protection. The economic evaluation of the most prevalent disorders is necessary to help health authorities know the reality of diseases and to establish working hypotheses that allow for a greater allocation of resources, which, for obvious reasons, are limited.1 These types of study are also necessary for health professionals, since they would require them to be more careful when making diagnostic and therapeutic decisions. The high prevalence of and the progressive increase in the rate of respiratory diseases, particularly asthma, in industrialised countries have transformed asthma into a serious problem, which is not only health related but also economic: it is estimated that the health expense incurred by the medical care and treatment of asthma in industrialised countries ranges between 1% and 2% of the total health expenditure.2-4 The recognition of the economic impact that asthma has on society is considered as an additional problem which needs to be taken into account when choosing the complete approach for this disease in the latest international consensus and the guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Pharmacoeconomics is one of the most interesting points in the evaluation of health resources, although it cannot be separated from the rest of the economic measures involved when caring for patients with asthma. From a pharmacoeconomic point of view, it is interesting to know, for example, the proportion of the patients responsible for the cost of this disease. According to studies carried out, the prevalence of asthma in Spain greatly varies between areas, ranging between 1% and 15%. These differences mainly depend on the methodology used to establish the diagnosis of the disease.5,6 It is expected that the economic impact of asthma will increase over the following years as a consequence of the rise in people’s life expectancy, the rise in prevalence and the appearance of new medicines and therapeutic modalities. When evaluating the costs incurred by a disease, these are subdivided into three major sections according to their nature: direct costs, indirect costs and intangible costs. Direct costs are incurred by resources consumed, including medicines, visits to doctors or health centres, such as the emergency department, hospitalisations and the cost of diagnostic methods and follow-ups carried out, such as function tests, X-rays and analyses. Indirect costs are related to lost resources, including money spent or not earned due to sick leaves, invalidities, early retirements and premature deaths. Intangible costs are linked with unattained potential profits due to the emotional impact and the loss of the quality of life caused by the disease to patients or their families, for example, when someone needs to leave his or her job to accompany a family member to the doctor. Direct costs are the easiest to quantify, given their condition, while indirect and intangible costs are the most difficult. Indirect costs depend, to a large extent, on the labour market and the social protection in each area. Intangible costs are even more difficult to measure, given their little quantifiable nature, so much so that in the majority of studies published, intangible costs are either not quantified or are added to the indirect costs. A bibliographic review on this issue reveals that there are few studies on pharmacoeconomics, although it is true that over the last ten years their number has been on the rise. However, the majority of these studies only quantify direct costs, or even a part of them, such as pharmaceutical expenses, thus providing an extremely partial view of the issue. Comparative studies are difficult to carry out, since the cost of asthma varies from country to country due to existing cultural, political, labour and economic differences and, above all, due to differences in the organisation of health systems in different countries that have published their data. The first authors dealing with this issue a few years ago were Weiss et al.2 in an article published in The New England Journal of Medicine in 1992, in which they showed that 1% of the health expenses in the USA were incurred by the treatment of asthma. Since then, other studies have been carried out in different industrialised countries, in which different methodologies have been used. In the E-mail address: jsb01b@saludalia.com