Economic Burden of Asthma Disease in Queensland - Research Proposal Example

Research Proposal Name: University: Date: Table of Contents Research Proposal 1 Name: 1 Table of Contents 2 Abstract 3 Aim 4 Objectives 5 Significance 5 Literature review 6 Research question and objective 10 Methodology 10 Study design 10 Data Collection 11 Study Sample 12 Cost components 12 Data analysis 13  Timescale 13 Resources 14 For the study to be successful, a number of resources such as portable computers, skilled manpower, instruments for measurement, transportation as well as other crucial supplies. Online academic databases and search engines, like Google Scholar, BioMed Central, and government websites will be used to gather information. A software known as Producteev will be used to complete and coordinate tasks with the research team, assign tasks to the researchers, measure the results, and keep the tasks organised. 14 References 15 Appendices 16 Research Proposal - Economic Burden of Asthma Disease in Queensland (QLD) Abstract Asthma is a disease that has a high economic burden not just in Australia but also globally. It affects the sufferers, their families as well as the community in general. This research paper will examine the economic burden of asthma at various levels and the difference between the severity and control of asthma. In the society, poor control of asthma has led to economic burden. In Queensland, the demand for acute or emergency health care services is exceedingly high because of uncontrolled asthma, which is very expensive as compared to the planned treatment. Asthma has both direct and indirect economic costs and the latter is associated with poorly controlled asthma which results in reduced productivity and performance as a result of increased rate of absenteeism. Essentially, when asthma is poorly controlled it results in significant economic burden, related to high costs not just to the patient but also to the community at large. As it will be demonstrated in this piece, the economic costs related to asthma are one of the highest amongst the chronic diseases mainly because if the increased use of health care services related to this condition. The asthma-related cost consists of both disease costs burden and economic costs. The economic costs components include productivity losses, health system costs, formal care, government programs, and deadweight efficiency losses. The main objective of this study will be to determine the economic burden of asthma disease in Queensland (QLD). Background/Introduction Asthma, as mentioned by Bahadori et al. (2009), is lungs’ inflammatory disorder which affects all people regardless of their age and it is a major contributor of mortality as well as morbidity globally. The condition’s prevalence is increasing in not just amongst the adults but also in children. According to Nunes, Pereira, and Morais-Almeida (2017), Asthma disease-related cost can be grouped into intangible, indirect and direct costs. The intangible costs are associated with unquantifiable losses, like reduced life quality, physical activities limitation, increases in suffering or pain, as well as job changes. On the other hand, the direct cost involve asthma management related costs( like medications, hospital admissions, outpatient visits, including and so forth), treatments or complementary investigations (such as blood and skin tests, imaging, and so forth) and other costs like transport, home care assistance, or professional preventive measures. Lastly, the indirect costs include losses associated with work (like temporary disability based on total or partial lost-days; permanent disability or early disability) as well as premature death. A mentioned by Nunes, Pereira, and Morais-Almeida (2017), the total asthma costs has enormous variation between countries and they rely on a number of factors: the country’s GDP, demographic and geographic status, public health financial resources, type of health system, relationship between pharmaceutical industries and governments with regard to medications, and data collection techniques. In 2004, WHO observed that the total asthma costs across the globe almost certainly surpass those of HIV/AIDS and tuberculosis combined (Nunes, Pereira, & Morais-Almeida, 2017). Aim To determine the economic burden of disease costs associated with asthma in QLD Objectives To examine the correlation between the costs of uncontrolled and controlled asthma therapy To explore the economic and social burden of asthma in Queensland society To determine whether the cost of asthma has any correlation with age, comorbidities, as well as disease severity To find out the hidden cost of asthma To summarise the health system expenditure and the disease burden Significance Understanding the asthma economic impact on Queensland society is very important since it facilitates the planning as well as the implementation of appropriate policies. In Australia, asthma is related to a high disease burden and it is prevalent amongst children and often lead to disability-adjusted life years (DALYs). Asthma symptoms are normally more common in developed countries, but the prevalence is also high a number of middle-income and low-income countries. Asthma is considered as a major public health problem that normally calls for utilisation of emergency care and hospital admission. Furthermore, it contributes enormously to high absenteeism in schools and workplaces. Asthma also can lead to premature death or early permanent disability. Actually, asthma is related to high limitations on professional/student, social and physical aspects of the life of the sufferers, particularly when uncontrolled. In general, costs associated with asthma are exceedingly high. The medical expenditures caused by asthma were considerably higher for patients with uncontrolled asthma than those people with controlled asthma. in Nunes, Pereira, and Morais-Almeida (2017), they observed that people that have uncontrolled asthma, when contrasted to those that do not have asthma, had nearly 4.6 times high hospitalisations frequency and nearly 1.8 times number of visits to the emergency department as well as reduced productivity. Similar results were found in several other surveys, namely in European asthmatic adults [14]. This study will summarise various aspects of the economic burden associated with asthma and it will also demonstrate the significance of pharmaceutical costs on driving asthma’s health care expenditure. Literature review In a survey conducted by Deloitte Australia (2015), they mentioned that asthma economic costs can be divided into various groups: (i) direct financial costs to the country’s health system which includes the costs of residential aged care facilities, running hospitals, specialist services, and general practitioners. Other direct costs, according to Deloitte Australia (2015), include pharmaceuticals’ costs, health administration, as well as the over-the-counter medications. (ii) Productivity costs are also associated with asthma, and normally include the asthmatic patients' productivity losses, premature death and also the informal care value. (iii) Administrative costs such as nongovernment and government programs like out-of-pocket expenses, community palliative care, respite, and funeral costs. (iv) Transfer costs, which involves the deadweight losses related to government transfers like disability, welfare, and revenue foregone payments. (v) Non-financial costs include the suffering, pain as well as the premature mortality that is caused by asthma. Even though it is exceedingly challenging to measure non-financial costs, Deloitte Australia (2015) posits that they can be analysed qualitatively and quantitatively based on the years of healthy life lost, normally recognised as ‘burden of disease’. Without a doubt, the economic burden associated with asthma does not only affect the patients but also their families, employers, friends, governments, non-governmental organisations, community groups and other society members. In Deloitte Australia (2015) survey, they listed sections of society that bear asthma-related costs: the Federal Government (by means of programs like the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) at a cost of $515.6 million as of 2015. Another section is the state and territory governments through hospital funding (in 2015 they spent $335 million). The third section is families and individuals (in 2015 they spent approximately $221.7 million in out-of-pocket hospital and co-payments expenditure); the last section is the charities, private health insurers and other parties who in 2015 spent $173.1 million in asthma-related costs (see appendix 1). In 2015, Australia’s total cost of asthma was a whopping $27.9 billion with the burden of disease and economic costs accounting for $24.7 billion and $3.3 billion, respectively (Deloitte Australia, 2015). In Queensland, asthma prevalence is high for men aged between 35-39 years and for women aged between 45- 49 years (see appendix two). In Bahadori et al. (2009) study, they observed that asthma was not just related to specific impairment on the patients, but was also related to a considerable cost to the society. The authors compared numerous studies that had examined asthma’s direct and indirect costs, and they observed that medications and hospitalisation were the main cost driver of direct costs whereas the school/work absenteeism was the primary driver of indirect costs. Bahadori et al. (2009) further established that the cost of asthma was correlated strongly with the disease severity, age and comorbidities. They established that cost of asthma significantly vary by hospital status, location, as well as ownership. In their study, Nunes, Pereira, and Morais-Almeida (2017) observed that asthma prevalence had been increasing across the globe. They emphasise that the disease as a lifelong condition has an exceedingly high economic burden. People with asthma normally utilise emergency care, every now and then they get hospitalised and have high absenteeism levels. Besides that, asthma can lead to premature death or early permanent disability. Even though asthma is widely recognised as a costly disease, its total cost to the society is yet to be measured in many countries. Nunes, Pereira, and Morais-Almeida (2017) posit that costs associated with asthma are exceedingly high and must be monitored systematically through standardized techniques; they have to take into consideration the disease’s natural history, prevalence as well as incidence trends, comorbidities, environmental impact, population ageing, quality of life, the guidelines implementation effect, and differences in income levels as well as national health systems. Some years ago, a number of guidelines were created at national and global levels with the aim of delineating improved strategies for diagnosis as well as treatment. These management programs were considered as a cost-effective strategy for managing asthma and reducing the disease’s economic burden. Zannetos, Zachariadou, Zachariades, Georgiou, and Talias (2017) utilised a cost of illness model with the aim of estimating the cost of asthma in Cyprus. They observed that asthma was a costly disease that needs strong national health policy. In Australia, as mentioned by ACAM (2005), asthma expenditure amongst the children was the highest. Every child aged below four years spends approximately $66 per girls and $76 per boy. The rate of expenditure was lowest amongst Australians aged between 25 and 34 years but was high among the older people. ACAM (2005) also observed that asthma-related expenditure was exceedingly high for females as compared to males. In the European Union (EU), Rysiak, Kuczynski, Zaręba, Mroz, and Pałka (2016) posit that the cost of treating asthma was close to 17.7 billion Euros while productivity losses attributed to uncontrolled asthma was nearly 9.8 billion euro annually. Rysiak, Kuczynski, Zaręba, Mroz, and Pałka (2016) cited a number of studies carried out in Finland reported, which established that treating patients with severe asthma was 13 times costly as compared to treating patients with mild asthma. The authors observed that high percentage of the expenditures associated with treating asthma was incurred for hospitalisation. In the United States, Asthma hospitalisations account for approximately 51.2 per cent of direct costs, outpatient treatment and temporary aid account for 18.4 percent and 10.5 percent, respectively while drugs subsidies account for 19.9 percent of the total costs. Rysiak, Kuczynski, Zaręba, Mroz, and Pałka (2016) also observed that asthma results in high nonmedical costs, normally recognised as indirect costs: dismissal from work, productivity loss, benefits care and sickness pension. This cost can be measured by exacerbations when the patient’s condition suddenly worsens. The authors posit that approximately 80 per cent of the asthma treatment funds consists of costs related to the exacerbations occurrence. Breathlessness’ severe attacks considerably worsen the condition of the patients and they could reduce their functioning, as well as increase drugs, use frequency to treat asthma. The authors concluded that asthma must be treated in the outpatient environment that is controlled properly with exacerbations avoidance. This result in cost reduction of direct costs associated with asthma, and therefore enhances the patient’s quality of life and lessens the direct costs related to the patients’ productivity loss. In Chastek et al. (2016) study, they observed that adjusted costs of asthma medication accounted for 79 percent of adjusted annual costs related to asthma in the severe asthma cohort and were three times percent greater as compared to the persistent asthma cohort. The authors further noted that higher costs of medication were a function not just for more prescription fills but as well for improved long-term observance to refill schedules for controller therapy amongst the severe asthma cohort versus the persistent asthma cohort: nearly 59% of severe asthmatic patients observed the long-term controller therapy than the persistent asthmatic patients. As mentioned by Chastek et al. (2016), adherence was a major challenge for asthmatic patients despite the fact that it is crucial for reducing the exacerbation risk. Research question and objective What is the level of economic burden of asthma costs in QLD? Is there a correlation between the costs of uncontrolled and controlled asthma therapy? Does the cost of asthma have any correlation with age, comorbidities, as well as disease severity? What is the hidden cost of asthma? Methodology Objective The study’s main objective is identifying as well as estimating the economic burden of asthma in Queensland, Australia, which includes the direct medical costs and the indirect costs associated with economy damage because of lower productivity and work absenteeism. Study design The study will utilise the retrospective approach where the emphasis will be placed on prevalence as well as both the direct and indirect costs of asthma. The retrospective approach will be appropriate because data will be gathered from previously recorded data. This approach would be beneficial because it is less time consuming since every relevant event has occurred already. The retrospective technique would be suitable because there are adequate observational datasets. In addition, bottom-up approach (Person-based data) and human capital approach will be utilised to calculate the direct costs and indirect costs, respectively. The study will also utilise the societal perspective that covers every costs aspect like indirect economic, mortality, and direct medical costs. A prevalence-based approach will be used to estimate asthma treatment and the costs attributed to the treatment. Illness cost studies that focus on prevalence, according to Zannetos, Zachariadou, Zachariades, Georgiou, and Talias (2017) are predominantly valuable when the study’s main purpose is warning the policy-makers the disease’s economic burden has been to some extent been underestimated. Besides that, these studies would guide the policymakers to design policies for cost containment because of the fact that such studies offer a depiction of the disease overall burden as well as the major components of cost, specifically the areas where policies related to cost containment will have a positive impact. The study will implement human capital approach with the aim of evaluating asthma’s indirect economic burden in Queensland. Basically, the human capital approach will hypothesise the patient’s perspective and also consider all man-hours that the asthmatic patients lost leading to productivity loss. All the patients’ indirect costs will rely on income as well as the total number of sick leaves attributed to nursing and patients care. Queensland’s income per capital will be utilised to calculate the asthmatic patients’ lost income. Data Collection The study participants will include youths and adults living in Queensland and data collection technique will include two stages. In the first stage, participants will be contacted by telephone before they are sent questionnaires which include questions regarding asthma suggestive symptoms, the utilisation of asthma medication, and the related cost burden. The second stage will involve a random sample of participants who will be given questionnaires and asked to take part in a more detailed interview. The questionnaire will include many questions associated with asthma symptoms, visits into the emergency department, hospital stays, asthma medications, outpatient visits, and work absenteeism. Study Sample For the first stage, the screening Questionnaire the participants will include a representative sample of Queenslanders aged above 18 years. More importantly, stratified random sampling will be carried out and Queensland, age and gender will be considered as strata. The participants will be contacted by telephone to inquire if they are willing to participate in the study. In general, 600 people are targeted for the questionnaires (and the response rate is expected to be at least 83%). For the second stage of the study, a random sample will be selected from people who take part in Stage one. Cost components The Direct costs related to asthma that the study will focus on include outpatient visits, hospital stays, emergency department visits, and asthma medications. The study will determine the overall cost by multiplying the number of asthmatic patients in Queensland all through 2016 with the cost per person. To determine the unit costs, the study will utilise the Queensland’s market prices since they reflect the society’s cost. The study will only include the costs of diagnosing and treating of asthma, but not the prevention costs. This is because the prevention costs rely on the person’s decision. In terms of indirect costs, the study will only focus on productivity losses attributed to asthma. According to the human capital approach, indirect costs exemplify the economy’s production loss because of work absenteeism. For that reason, productivity losses because of asthma will be estimated. To determine the cost of asthma, a bottom-up approach will be utilised to quantify the resources used as well as the individuals’ productivity loss because of asthma. Therefore, mean per-person costs will be extrapolated to Queensland’s entire population by utilising the available prevalence data. Data analysis The SPSS will be used to analyse the gathered data in order to accelerate the interpretation of the participant’s responses and representing data in a manner that can be easily interpreted. Through the SPSS software, the participants’ responses will be represented in form of nominal variables to facilitate data representation. More importantly, the SPSS will be utilised to provide percentage distributions in order to facilitate the indication of nominal variable variability and to show cumulative percentage. The costs of asthma will be estimated using Microsoft Excel 2007 and Bootstrap simulations will be performed for sensitivity analysis.  Timescale Task May (2017) June – July (2017) August(2017) September (2017) October (2017) Proposal Literature Review Preliminary field work as well as research Formulating research question and methods Completion of the draft report  Revising report Data collection and analysis Report writing Publishing the report Submitting the report Resources For the study to be successful, a number of resources such as portable computers, skilled manpower, instruments for measurement, transportation as well as other crucial supplies. Online academic databases and search engines, like Google Scholar, BioMed Central, and government websites will be used to gather information. A software known as Producteev will be used to complete and coordinate tasks with the research team, assign tasks to the researchers, measure the results, and keep the tasks organised. References ACAM. (2005). Health care expenditure and the burden of disease due to asthma in Australia. Australian Centre for Asthma Monitoring. Canberra: AIHW. Bahadori, K., Doyle-Waters, M. M., Marra, C., Lynd, L., Alasaly, K., Swiston, J., & FitzGerald, J. M. (2009). Economic burden of asthma: a systematic review. BMC Pulmonary Medicine, 9(24), 1-16. Chastek, B., Korrer, S., Nagar, S. P., Albers, F., Yancey, S., Ortega, H., . . . Dalal, A. A. (2016). Economic Burden of Illness Among Patients with Severe Asthma in a Managed Care Setting. Journal of Managed Care & Specialty Pharmacy, 22(7), 848-861. Deloitte Australia. (2015). The Hidden Cost of Asthma. Barton ACT: Deloitte Access Economics Pty Ltd. Nunes, C., Pereira, A. M., & Morais-Almeida, M. (2017). Asthma costs and social impact. Asthma Research and Practice, 3(1), 1-11. Rysiak, E., Kuczynski, A., Zaręba, I., Mroz, R. J., & Pałka, J. (2016). Evaluation of the treatment costs of asthma exacerbations in outpatients. Acta Poloniae Pharmaceutica ñ Drug Research, 73(1), 239ñ245. Zannetos, S., Zachariadou, T., Zachariades, A., Georgiou, A., & Talias, M. A. (2017). The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study. BMC Public Health, 17, 1-9. Appendices Appendix One: Breakdown of health system costs Appendix Two: Asthma prevalence in Queensland Read More