Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country

Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51%) were females. Also, 72 (65%) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US$368.4 (±228) per patient. Medication cost accounted for the majority (87%) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted. 1. Introduction Bronchial asthma is a common chronic respiratory disease worldwide [1]. According to the Global Initiative for Asthma (GINA), it affects 5.4% of adults in Nigeria, and its prevalence is increasing [1–3]. A recent study showed a low level of asthma control among adult asthmatics in Nigeria [4]. Poorly controlled asthma imposes a substantial economic impact on the patient and health system, primarily through direct costs from followup, hospitalization, and medications and indirect costs from lost productivity [5, 6]. A previous study showed that the cost of regular treatment of chronic diseases including asthma is unaffordable to families in low-resource settings [7, 8]. This results in a considerable high proportion of uncontrolled asthma, which is associated with greater economic burden to families and the health system and deterioration in quality of life [7–9]. In high-/middle-income countries, costs of asthma inpatient care [10], hospitalization [10–12], and exacerbations [13] have been previously documented. However, reports on cost of asthma followup among individuals with poorly controlled asthma are lacking worldwide. Furthermore, no data exists on the economic impact of asthma care on patients in Africa. In a recent systematic review, no single study from the region was