Modelization of cost assessment in childhood asthma is essential for policy makers

Asthma is a major chronic disease throughout the world affecting all ages (1). Within the European Union (EU), prevalence of childhood asthma (wheeze) ranges from 5.7% in Greece to 25.3% in England (2). With an increasing incidence, dozens of millions of children and adults are concerned. Asthma is a serious global health problem and represents a significant burden, with a substantial economic impact on the affected persons, their families, the health care systems and society as a whole and reduced participation in family life (3). This burden is composed of direct expenditures generated within the health care system, indirect costs associated with the loss of economic productivity and intangible costs corresponding to the quality of life of children as well as of their parents. However, it is difficult to translate such a subjective notion into an objective and economic evaluation as most quality of life scales used in children and their parents do not include an economic value (4–6). In children with uncontrolled asthma, the children and their parents are obliged to stay at home, or if this is not possible, the parents have to employ a caregiver to look after their child, thereby increasing indirect costs. Asthmatics are frequently required to make choices on how to re-allocate their personal and family resources. The economic burden of these conditions also affects school and work productivity (7). Health economic outcomes are increasingly being relied upon as a decision-making source for health care providers. Economic analysis can help to set priorities and maximize management strategies for cost control without sacrificing safety, efficacy or effectiveness. Member states of the EU have different socio-economic levels and health care systems. Effective antiasthma medications are available in all EU countries but they may not be affordable for all patients. Moreover, indirect costs (e.g. a working day lost) vary widely between countries. Different viewpoints should be considered. Patients always desire an optimal treatment in terms of efficacy and safety. However, they have a different perspective depending on the health system. If their medical insurance or the health care system were to reimburse all medical expenses, patients would be unrestricted and could use health care resources and funds excessively. The economic evaluation will be truncated and, for the patients, indirect and intangible costs will represent the only costs. On the contrary, if patients are obliged to pay medical costs partly or completely, they would also want to have a more cost-effective treatment which, unfortunately, may not be the optimal one (e.g. inhaled corticosteroids vs combination therapy). In lowand middle-income countries, childhood asthma has a significant adverse impact on finances, with the average monthly expenditure on a child’s medication sometimes over one-third of the monthly per capita income (8). Ideally, the model should provide a societal perspective by taking into account all the costs including school and indirect working days lost (for parents) and quality of life. Health care has a cost and resources are limited. The knowledge of the cost-of-illness of asthma is very important, particularly for a frequent and chronic disease that concerns children and adults. There has been considerable evidence of the cost-effectiveness of treating asthmatic patients, especially considering its high prevalence, morbidity, mortality, and concomitant health care P. J. Bousquet, J.-P. Daures Exploration des Allergies, Service des Maladies Respiratoires, INSERM U454, H pital Arnaud de Villeneuve, Universit de Montpellier, 34295 Montpellier Cedex 5; D partement de l'Information M dicale, H pital Caremeau, Place du Professeur Robert Debr , 30029 Nimes Cedex 9; Laboratoire de Biostatistiques, Epid miologie et Recherche Clinique, IURC, 34000 Montpellier, France