Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013
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1 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
2 Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013
3 Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013
4 Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013
5 Estimating the Cost of Pediatric Asthma Attributable to the Environment Michigan, 2013
6 Previous studies Landrigan, 2002 States, 2003-present Trasande, 2012 Background
7 Components of Cost Direct costs Medical (inpt, outpt, ED, dr visits, R x med) Indirect costs Premature death Parents lost workdays
8 Key Concepts Medical Expenditure Panel Survey Incremental Cost Environmentally Attributable Fraction
9 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%
10 Adjusting for inflation Consumer Price Index Overall Medical Care Methods
11 Methods CDC s Chronic Disease Cost Calculator Calculates Direct costs Indirect costs for missed workdays only Costs based on Medical Expenditure Panel Survey (MEPS)
12 Methods Target year: 2013 Triangulation Method 1 Use CDC s Chronic Disease Cost Calculator Adjust for inflation Calculate costs for premature deaths separately Method U.S. results Adjust to 2013 dollars Apply to MI population
13 Method 1 Cost Calculator Inputs: Input Value Used
14 Method 1 Cost Calculator Inputs: Input Value Used 2013 MI population aged ,246,889
15 Method 1 Cost Calculator Inputs: Input Value Used 2013 MI population aged ,246,889 % of 0-17 treated for asthma 6.5%
16 Method 1 Cost Calculator Inputs: Input Value Used 2013 MI population aged ,246,889 % of 0-17 treated for asthma 6.5% # of lost workdays due to asthma 2.5 days
17 Method 1 Cost Calculator Inputs: Input Value Used 2013 MI population aged ,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)
18 Method 1 Cost Calculator Results: Measure Direct (Medical) $153 Indirect (Lost Workdays) $40 Cost (in millions) 2010 dollars 2013 dollars
19 Method 1 Cost Calculator Results: Measure Cost (in millions) 2010 dollars 2013 dollars Direct (Medical) $153 $167 Indirect (Lost Workdays) $40 $43
20 Method 1 Indirect costs due to asthma deaths Per person lifetime economic productivity 2007 (Trasande) Male $1,711,000 Female $1,392,000
21 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
22 Method 1 Indirect costs due to asthma deaths Per person lifetime economic productivity 2007 (Trasande) 2013 # Asthma Deaths 2013 Cost (Millions) Male $1,711,000 $1,922,000 3 $5.767 Female $1,392,000 $1,564,000 3 $4.692 Total: $ Million
23 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
24 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
25 Method 2
26 Method 2 Direct Cost per person w/asthma Indirect Cost per person w/asthma US 2008 $585 $560
27 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%
28 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%
29 Method 2 Number of MI Children w/asthma, ,422
30 Method 2 Number of MI Children w/asthma, ,422 Direct Cost 238,422 x $683 = $162,842,226 Indirect Cost 238,422 x $606 = $144,483,732
31 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
32 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
33 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
34 Assumptions 1. MI = US for direct & indirect costs per person 2. Medical Care CPI accurate for asthma 3. EAF of 30% applicable to MI
35 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
36 Discussion For full impact of environment on medical care costs Use all ages Look at other health conditions (e.g., cancer, lead poisoning)
37 Next Steps Develop paper Develop fact sheet
38 Acknowledgments MI EPH Tracking Team Beth Anderson Bob Wahl Chris Fussman
39 Thank You!
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