부산대학교 도서관

The economic burden of asthma is significant and distributed disproportionately among those with severe disease. Asthma-related deaths in more developed countries like the UK have stabilised or are in decline however recent evidence suggests that individuals with asthma face greater all-cause mortality. Comorbidity is also more common in asthma and recent evidence has implicated corticosteroids, a cornerstone of treatment, in induced morbidity. The question of how much of the asthma burden can be avoided involves a consideration of the competing harms. This thesis aims firstly to explore the evidence regarding the cost of corticosteroid-induced morbidity in asthma through a systematic literature review before applying regression analysis to estimate the cost of corticosteroid-induced morbidity as well as considering biologically plausible subgroups, age and sex, in which this burden manifests. This thesis aims finally to explore the socioeconomic context within which this burden occurs through the use of a measure of stress-related “wear and tear” called allostatic load. This potentially avoidable burden is explored using a number health and social databases from the UK. This thesis provides estimates of the cost of corticosteroid-induced morbidity for individuals with severe asthma relative to those with mild/moderate asthma and no asthma in the UK. This cost is much larger than estimates used to inform the cost-effectiveness of novel corticosteroid-sparing therapies in the UK and is consistent with other research published in the intervening period. It is shown that this burden is not evenly spread across the life course. Corticosteroid exposure potentially “brings forward” the expression of many comorbidities common in asthma suggesting younger individuals may benefit most from increased access to these expensive therapies. Finally this notion of early aging in relation to corticosteroid exposure is put in context in relation to the Grossman model for the demand for health and implications discussed.