RATIONALE:

Despite effective treatments, a large proportion of asthma patients do not achieve sustained asthma control. The 'preventable' burden associated with lack of proper control is likely taking a high toll at the personal and population level. OBJECTIVE:

We predicted the future excess health and economic burden associated with uncontrolled asthma among American adolescents and adults for the next 20 years. METHODS:

We built a probabilistic model that linked state-specific estimates of population growth and aging, asthma prevalence, and asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state-level, total direct and indirect (due to productivity loss) costs (in 2018 dollars) and QALYs lost due to uncontrolled asthma from 2019 to 2038. MEASUREMENTS AND MAIN RESULTS:

Total 20-year direct costs associated with uncontrolled asthma are estimated to be $300.6 billion (95% confidence interval [CI] $190.1-$411.1). When indirect costs are added, total economic burden will be $963.5 billion (95%CI $664.1B-$1,262.9B). American adolescents and adults will lose an estimated 15.46 million (95%CI 12.77M-18.14M) QALYs over this period due to uncontrolled asthma. CONCLUSION:

The burden of uncontrolled asthma is substantial and will continue to grow. Given that a substantial fraction of this burden is preventable, better adherence to evidence-informed asthma management strategies by care providers and patients has the potential to substantially reduce costs and improve quality of life. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).