Current and future medical costs of asthma and chronic obstructive pulmonary disease in the Netherlands

The aim of this study was to estimate the healthcare costs of asthma and ch ronic obstructive pulmonary disease (COPD), in the Netherlands, in 1993. Al so studied was the future development of these costs, as a result of ageing and possible changes in smoking behavior. A prevalence-based cost-of-illness approach was used to estimate direct med ical costs. Age- and gender-specific data were obtained from representative national registries and large, representative surveys. To model future cos ts, cost estimates were linked to an epidemiological model based on a dynam ic multi-state lifetable. It describes 1 yr changes, from one state to anot her, that result from ageing, birth, migration, incidence, recovery from as thma and death due to asthma, COPD or other causes, and starting or quittin g smoking. Three different scenarios were modelled: 1) a reference scenario which primarily predicts the impact of ageing. 2) an 'attainable' smoking reduction scenario and 3) an 'extreme' smoking reduction scenario. Direct medical costs were estimated to be $US 346 million in 1993. With inc reasing age, the relative importance of asthma in total asthma and COPD cos ts decreased from 91% to less than 4%. Annual costs per patient were estima ted to be $US 499 for asthma and $US 876 for COPD. The breakdown of costs d iffered considerably between asthma and COPD. The reference scenario predicted the costs to increase by 60% to reach $US 555 million by 2010. COPD prevention as modelled in the second and the thir d scenario reduced the projected cost increase from 60%, to 57% and 48%, re spectively. Together, the direct costs of asthma and COPD represent 1.3% of the Dutch h ealth care budget: The breakdown of the costs shows different patterns for asthma and COPD. The-costs of these diseases are expected to increase by 60 % in the near future. In the short run the impact of smoking reduction on r educing this increase is relatively small, but it will be greater in the lo ng run. (C) 1999 HARCOURT PUBLISHERS LTD.