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      The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases

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          Abstract

          Background

          There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma.

          Methods

          We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010–11, and routine administrative, health and social care datasets for 2011–12; 2011–12 costs were estimated in pounds sterling using economic modelling.

          Results

          The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7–31.3; n = 18.5 million (m) people) and 15.6 % (14.3–16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9–10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7–5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths.

          Conclusions

          Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12916-016-0657-8) contains supplementary material, which is available to authorized users.

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          The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.

          The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five-point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p less than 0.0001).
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            Decision Modelling for Health Economic Evaluation

            In financially constrained health systems across the world, increasing emphasis is being placed on the ability to demonstrate that health care interventions are not only effective, but also cost-effective. This book deals with decision modelling techniques that can be used to estimate the value for money of various interventions including medical devices, surgical procedures, diagnostic technologies, and pharmaceuticals. Particular emphasis is placed on the importance of the appropriate representation of uncertainty in the evaluative process and the implication this uncertainty has for decision making and the need for future research. This highly practical guide takes the reader through the key principles and approaches of modelling techniques. It begins with the basics of constructing different forms of the model, the population of the model with input parameter estimates, analysis of the results, and progression to the holistic view of models as a valuable tool for informing future research exercises. Case studies and exercises are supported with online templates and solutions. This book will help analysts understand the contribution of decision-analytic modelling to the evaluation of health care programmes. [Ed.]
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              Is the prevalence of asthma declining? Systematic review of epidemiological studies.

              Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.
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                Author and article information

                Contributors
                +44 (0)131 650 3813 , mome.mukherjee@ed.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                29 August 2016
                29 August 2016
                2016
                : 14
                : 1
                : 113
                Affiliations
                [1 ]Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH8 9AG UK
                [2 ]Edinburgh Clinical Trials Unit, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH8 9AG UK
                [3 ]Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
                [4 ]School of Health Sciences, University of Tampere, 33014 Tampere, Finland
                [5 ]Swansea Centre for Health Economics (SCHE), College of Human and Health Science, Swansea University, Singleton Park, Swansea, SA2 8PP UK
                [6 ]Farr Institute, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP UK
                [7 ]The University of Edinburgh & The Royal College of Surgeons of Edinburgh, Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA UK
                [8 ]Information Services Division (ISD), NHS National Services Scotland, Room 111, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB UK
                [9 ]School of Geosciences, The University of Edinburgh, Edinburgh, EH8 9AG UK
                [10 ]Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome Wolfson Institute Experimental Medicine, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
                [11 ]Asthma & Allergy Group, Institute of Life Science, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP UK
                Author information
                http://orcid.org/0000-0002-3083-436X
                Article
                657
                10.1186/s12916-016-0657-8
                5002970
                27568881
                c9a02495-62bd-4739-8323-2f495005c787
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 March 2016
                : 15 July 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000362, Asthma UK;
                Award ID: AUK-PG-2012-178
                Award Recipient :
                Funded by: Edinburgh Clinical Trials Unit (ECTU)
                Funded by: The Farr Institute
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine
                asthma,epidemiology,burden,cost,uk
                Medicine
                asthma, epidemiology, burden, cost, uk

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