Estimating the Cost of Pediatric Asthma Attributable to the - - PowerPoint PPT Presentation

Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013

Thomas Largo, MPH Division of Environmental Health Michigan Department of Health and Human Services

Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013

Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013

Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013

Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013

Background

• Previous studies
• Landrigan, 2002
• States, 2003-present
• Trasande, 2012

Components of ‘Cost’

• Direct costs
• Medical (inpt, outpt, ED, dr visits, Rx med)
• Indirect costs
• Premature death
• Parents’ lost workdays

Key Concepts

• Medical Expenditure Panel Survey
• Incremental Cost
• Environmentally Attributable Fraction

Methods

• Environmentally Attributable Fraction (EAF)
• Pediatric Asthma
• Acute exacerbations
• Outdoor pollutants (e.g., excludes pets, tobacco smoke, mold, insects)
• Best estimate: 30%
• Lower bound: 10%
• Upper bound: 35%

Methods

• Adjusting for inflation
• Consumer Price Index
• Overall
• Medical Care

Methods

• CDC’s Chronic Disease Cost Calculator
• Calculates
• Direct costs
• Indirect costs for missed workdays only
• Costs based on Medical Expenditure Panel Survey (MEPS)

Methods

• Target year: 2013
• Triangulation
• Method 1
• Use CDC’s Chronic Disease Cost Calculator
• Adjust for inflation
• Calculate costs for premature deaths separately
• Method 2
• 2008 U.S. results
• Adjust to 2013 dollars
• Apply to MI population

Method 1

Cost Calculator Inputs:

Input Value Used

Method 1

Cost Calculator Inputs:

Input Value Used

2013 MI population aged 0-17 2,246,889

Method 1

Cost Calculator Inputs:

Input Value Used

2013 MI population aged 0-17 2,246,889 % of 0-17 treated for asthma 6.5%

Method 1

Cost Calculator Inputs:

Input Value Used

2013 MI population aged 0-17 2,246,889 % of 0-17 treated for asthma 6.5% # of lost workdays due to asthma 2.5 days

Method 1

Cost Calculator Inputs:

Input Value Used

2013 MI population aged 0-17 2,246,889 % of 0-17 treated for asthma 6.5% # of lost workdays due to asthma 2.5 days Cost of medical treatment per year $1,050 (2010 dollars)

Method 1

Cost Calculator Results:

Measure Cost (in millions)

2010 dollars 2013 dollars

Direct (Medical) $153 Indirect (Lost Workdays) $40

Method 1

Cost Calculator Results:

Measure Cost (in millions)

2010 dollars 2013 dollars

Direct (Medical) $153 $167 Indirect (Lost Workdays) $40 $43

Method 1

Indirect costs due to asthma deaths

Per person lifetime economic productivity 2007 (Trasande) Male $1,711,000 Female $1,392,000

Method 1

Indirect costs due to asthma deaths

Per person lifetime economic productivity 2007 (Trasande) 2013 Male $1,711,000 $1,922,000 Female $1,392,000 $1,564,000

Method 1

Indirect costs due to asthma deaths

Per person lifetime economic productivity # Asthma Deaths 2013 Cost (Millions) 2007 (Trasande) 2013 Male $1,711,000 $1,922,000 3 $5.767 Female $1,392,000 $1,564,000 3 $4.692

Total: $10.459 Million

Method 1

Type of Cost Overall Cost Environmentally-Attributable Cost (in millions)

Assuming EAF=10%

Assuming EAF=30%

Assuming EAF=35%

Direct $167,000,000

$50.1

Indirect $53,459,000

$16.0

Total $220,459,000

$66.1

Method 1

Type of Cost Overall Cost Environmentally-Attributable Cost (in millions)

Assuming EAF=10%

Assuming EAF=30%

Assuming EAF=35%

Direct $167,000,000

$16.7

$50.1

$58.5

Indirect $53,459,000

$5.3

$16.0

$18.7

Total $220,459,000

$22.0

$66.1

$77.2

Method 2

Method 2

Direct Cost per person w/asthma Indirect Cost per person w/asthma US 2008 $585 $560

Method 2

Direct Cost per person w/asthma Indirect Cost per person w/asthma US 2008 $585 $560 US 2013 $683 $606

Medical Care CPI – avg annual increase: 3.35% Overall CPI – avg annual increase: 1.64%

Method 2

Direct Cost per person w/asthma Indirect Cost per person w/asthma US 2008 $585 $560 US 2013 $683 $606 MI 2013 $683 $606

Medical Care CPI – avg annual increase: 3.35% Overall CPI – avg annual increase: 1.64%

Method 2

Number of MI Children w/asthma, 2013 238,422

Method 2

Number of MI Children w/asthma, 2013 238,422 Direct Cost 238,422 x $683 = $162,842,226 Indirect Cost 238,422 x $606 = $144,483,732

Method 2

Type of Cost Overall Cost Environmentally-Attributable Cost (in millions)

Assuming EAF=10%

Assuming EAF=30%

Assuming EAF=35%

Direct $162,842,226 Indirect $144,483,732 Total $307,325,958

Method 2

Type of Cost Overall Cost Environmentally-Attributable Cost (in millions)

Assuming EAF=10%

Assuming EAF=30%

Assuming EAF=35%

Direct $162,842,226

$48.9

Indirect $144,483,732

$43.3

Total $307,325,958

$92.2

Method 2

Type of Cost Overall Cost Environmentally-Attributable Cost (in millions)

Assuming EAF=10%

Assuming EAF=30%

Assuming EAF=35%

Direct $162,842,226

$16.3

$48.9

$57.0

Indirect $144,483,732

$14.4

$43.3

$50.6

Total $307,325,958

$30.7

$92.2

$107.6

Assumptions

• 1. MI = US for direct & indirect costs per person
• 2. Medical Care CPI accurate for asthma
• 3. EAF of 30% applicable to MI

Discussion

• Direct costs very similar ($50.1 v. $48.9)
• Cost calculator easy to use
• Difference in indirect costs – Method 1 v. Method 2
• Other MI study (2010): $88.4 million
• Direct + Indirect

Discussion

• For full impact of environment on medical care costs
• Use all ages
• Look at other health conditions (e.g., cancer, lead poisoning)

Next Steps

• Develop paper
• Develop fact sheet

Acknowledgments

• MI EPH Tracking Team
• Beth Anderson
• Bob Wahl
• Chris Fussman

Thank You!