ArticleThe journal of allergy and clinical immunology. Global2025
Guideline-based asthma treatment in Asia: Insights from a robust time-in-state model.
Article in The journal of allergy and clinical immunology. Global, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The landscape of guideline-based asthma treatment in Asia remains unclear. Objective: Leveraging current evidence, we predicted the long-term economic impact of guideline-based asthma treatment in Asian countries, using Singapore as a case study. Methods: We systematically reviewed evidence between 2014 and 2024 on asthma prevalence, adherence to inhaled corticosteroid (ICS) with or without long-acting β-agonist (LABA), and frequency of short-acting β-agonist (SABA) use in Asian asthma populations. We developed a time-in-state model for the joint impact of ICS/ICS-LABA adherence and SABA use on the economic and humanistic burden of uncontrolled asthma during 2024 to 2043. Accordingly, we projected 20-year total direct costs, indirect costs, and quality-adjusted life-years (QALYs) lost associated with uncontrolled asthma in Singapore and assessed the varied impact of guideline-based asthma treatment. Results: Among 28 Asia-based, population-level studies, asthma prevalence was 1% to 12% in adults and 2% to 14% in children. ICS/ICS-LABA adherence, reported in only 3 countries, ranged from 10% to 90%; average SABA use was 2.5 to 6.4 canisters/year. In Singapore, under current trends of ICS/ICS-LABA adherence and SABA use, the 20-year burden of uncontrolled asthma is SGD$2.772 billion in direct costs, SGD$5.670 billion in indirect costs, and 58,872 QALYs lost. Optimizing guideline-based treatment nationwide (ICS/ICS-LABA medication possession ratio = 0.8, SABA use = 1 canister/year) reduces 20-year direct costs, indirect costs, and QALYs lost by 27.7%, 23.8%, and 28.8%, respectively. Conclusions: Population-based evidence on guideline-based asthma treatment in Asia is limited. Population-level modeling of its economic impact, using minimal key evidence, revealed substantial reduction in societal economic and humanistic burden in Asian countries such as Singapore.
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