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The association between asthma control, health care costs, and quality of life in France and Spain

Marianne Doz1, Christos Chouaid2, Laure Com-Ruelle3, Eduardo Calvo4, Max Brosa5, Julien Robert1, Laurent Decuypère6, Celine Pribil6, Alicia Huerta7 and Bruno Detournay1*

Author Affiliations

1 Cemka-Eval, 43 Boulevard du Maréchal Joffre, Bourg-la-Reine, F-92340, France

2 APHP, Hôpital Saint-Antoine, Service de Pneumologie, 184 rue du Fbg Saint-Antoine, Paris, F-75571 cedex 12, France

3 Institut de recherche et documentation en économie de la santé (IRDES), 10 rue Vauvenargues, Paris, F-75018, France

4 Centro de Salud Universitario Pozuelo Estación, Madrid, Spain

5 Oblikue Consulting, C/ Josep Irla i Bosh, 5-7, 1ª planta S-08034, Barcelona, Spain

6 GlaxoSmithKline, 100 Route de Versailles, Marly-le-Roi cedex, France

7 GlaxoSmithKline, Parque Tecnologico de Madrid, Severo ochoa 2, S-28760 Tres Cantos, Madrid, Spain

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BMC Pulmonary Medicine 2013, 13:15  doi:10.1186/1471-2466-13-15

Published: 22 March 2013



Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.


An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.


2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.

For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).


In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

Adult asthmatic patients; Asthma guidelines; EQ-5D-3L®; Drugs cost; Economic evaluation