Healthcare expenditure and its socio-demographic and clinical predictors in Australians with poorly controlled asthma

PLOS ONE RESEARCH ARTICLE Healthcare expenditure and its sociodemographic and clinical predictors in Australians with poorly controlled asthma Stella T. Lartey ID1,2*, Thomas Lung3,4, Sarah Serhal ID5,6, Luke Bereznicki7, Bonnie Bereznicki8, Lynne Emmerton ID9, Sinthia Bosnic-Anticevich5,6, Bandana Saini5,6, Laurent Billot3,10, Ines Krass6, Carol Armour5,11, Stephen Jan3,10 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom, 2 NIHR Applied Research Collaboration, East of England, United Kingdom, 3 The George Institute for Global Health, Sydney, Australia, 4 School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia, 5 Woolcock Institute of Medical Research, Sydney, New South Wales, Australia, 6 School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia, 7 College of Health and Medicine, University of Tasmania, Hobart, Australia, 8 Tasmanian School of Medicine, Hobart, Tasmania, Australia, 9 Curtin Medical School, Curtin University, Perth, Western Australia, Australia, 10 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia, 11 Central Sydney Area Health Service, Sydney, New South Wales, Australia * OPEN ACCESS Citation: Lartey ST, Lung T, Serhal S, Bereznicki L, Bereznicki B, Emmerton L, et al. (2023) Healthcare expenditure and its socio-demographic and clinical predictors in Australians with poorly controlled asthma. PLoS ONE 18(1): e0279748. https://doi. org/10.1371/journal.pone.0279748 Editor: Siew Chin Ong, Universiti Sains Malaysia, MALAYSIA Abstract Introduction Asthma has substantial and increasing health and economic burden worldwide. This study aimed to estimate healthcare expenditure and determine the factors that increase expenditure in Australians with poorly controlled asthma. Received: April 3, 2022 Accepted: December 1, 2022 Published: January 5, 2023 Copyright: © 2023 Lartey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data presented in this article can be accessed and are subject to approval by Services Australia prior to distribution. Access requires processes due to the General Data Protection Regulations (or Australian Privacy Principles) for data distribution. Once these processes are duly followed, raw data will be granted by Service Australia. Further information and contact to request data from Services Australia can be found here: https://www.servicesaustralia. gov.au/statistical-information-and-data?context= 1#a1. Methods Individuals �18 years of age with poorly controlled asthma, as determined by a score �1.5 on the Asthma Control Questionnaire, were included in the study. Healthcare utilization costs from medical services and medications were estimated over an average follow-up of 12 months from administratively linked data: the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. A generalized linear model with gamma distribution and log link was used to predict participants’ key baseline characteristics associated with variations in healthcare costs. Results A total of 341 participants recruited through community pharmacies were included. The mean (standard deviation, SD) age of participants was 56.6 (SD 17.6) years, and approximately 71% were females. The adjusted average monthly healthcare expenditure per participant was $AU386 (95% CI: 336, 436). On top of the average monthly costs, an incremental expenditure was found for each year increase in age ($AU4; 95% CI: 0.78, 7), being unemployed ($AU201; 95% CI: 91, 311), one unit change in worsening quality of life ($AU35; 95% CI: 9, 61) and being diagnosed with depression and anxiety ($AU171; 95% CI: 36, 306). PLOS ONE | https://doi.org/10.1371/journal.pone.0279748 January 5, 2023 1 / 16 PLOS ONE Funding: This work was supported by the Commonwealth of Australia as represented by the Department of Health via the Sixth Community Pharmacy Agreement (6CPA). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data or in the writing of this manuscript. Competing interests: Sinthia Bosnic-anticevich has received honorarium for invited lectures and consultancy on expert advisory boards for Teva, AsteraZeneca, Sanofi, GSK, Mylan, Boehringer Ingelheim and research grants from AstraZeneca, Teva, Mylan, Viatris and GSK, the Australian Research Council, Department of Health and Aging, University of Sydney, Commonwealth Govt of Australia (Guild Govt Agreement Scheme), Commonwealth Govt of Australia (Rural and Remote Pharmacy Workforce Development Program), NHMRC Co-operative Research Centre for Asthma, NHMRC Centre for Research Excellence in Severe Asthma, Asthma Foundation of NSW, Research in Real Life Pty (UK), University of Michigan, USA. All other co-authors declare no conflict of interest and no competing interests. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Healthcare expenditure predictors in Australians with poorly controlled asthma Conclusions In a cohort of Australian patients, characterized by poor asthma control and co-morbidities individuals impose substantial economic burden in terms of Medicare funded medical services and medications. Programs addressing strategies to improve the quality of life and manage co-morbid anxiety and depression and encourage asthma patients’ engagement in clinically tolerable jobs, may result in significant cost savings to the health system. Introduction Asthma is a major cause of disease burden worldwide, with an estimated prevalence of approximately 358 million people and 400,000 deaths in 2015 [1]. This prevalence has increased over the last decade [1–3] and is predicted to reach 400 million cases by 2025 [4]. Asthma is among the top-ranked causes of disability-adjusted life-years (DALYs)–being one of the top 30 conditions in terms of disease burden in under 24 years and over 50 years age groups [5]. This results in substantial healthcare expenditure and overall economic burden [2, 6–8], which has been observed to increase notably with severity and with poorer asthma control [7, 9]. Individuals with poorly controlled asthma tend to have frequent and intense episodes of symptoms, leading to emergency department visits and hospitalization [6, 7, 10]. In Aus (...truncated)