Lung disease a drain on coffers. (Environmental Medicine).

Medical care for people with chronic respiratory diseases cost Americans $45.3 billion in 1996, according to a University of California at San Francisco study published in the 1 March 2002 issue of the European Respiratory Journal. The study extrapolated these results and more from data gathered under the Medical Expenditure Panel Survey (MEPS), an ongoing survey of how Americans--as represented by a sample of 21,571 individuals--use and pay for health services.

The study focused on the cost of medical care given to individuals who have asthma, chronic bronchitis, chronic airway obstruction, and other major respiratory diseases, compared with costs for people who do not have serious lung problems. More than 4.5% of the survey respondents--1,027 people--reported one or more serious respiratory conditions, allowing researchers to make a weighted estimate that 12.1 million people in the United States have similar conditions. More than 80% of the MEPS respondents who had respiratory disease also had other chronic illnesses such as heart disease and diabetes that added significantly to the cost of personal medical care.

The costs associated with respiratory diseases were teased out by tabulating all health care costs, then eliminating those that could be attributed to other diseases present at the same time in the same patients. Total annual medical care costs averaged $3,753 for people with respiratory conditions, with 45% of those dollars going to hospital stays and another 17% to prescription drugs. "In some sense, the expenditure data we've talked about in the paper give you the benefits to be gained by intervention," says lead author Edward Yelin. "They make an important contribution to health policy debate."

Expenses directly connected to respiratory diseases accounted for only $1,003-2,588 of the costs for each respiratory disease patient, allowing the researchers to attribute $12.1-31.2 billion of respiratory patient expenses directly to respiratory diseases themselves. According to Yelin, the study looked at costs as a whole, not necessarily broken down by who pays what. But costs could also be considered from the perspective of insurance companies or individuals' out-of-pocket expenses, Yelin says. Policies that lead to improvement in respiratory health--for example, by directing more resources toward intervention strategies that help patients avoid hospitalization--might save some of those dollars.

The current iteration of the MEPS, which began in 1996 and continues to gather data in two-year chunks, is the third and most recent U.S. national survey of health costs conducted by the federal Agency for Healthcare Research and Quality in collaboration with the National Center for Health Statistics and the survey research firm Westat. National data are available on the agency website at http://www.meps.ahrq.gov/.