ArticleThe World Allergy Organization journal2025
Economic burden of asthma multimorbidity in Singapore: Shadow costs of steroid use.
Article in The World Allergy Organization journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Asthma and Multimorbidity Amongst Ethnic Minority Groups in High Income Countries.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Review
- Article
- Projecting the 20-year healthcare resource burden of asthma and COPD multimorbidity: insights from Singapore for integrated chronic respiratory care in South-East Asia.NPJ primary care respiratory medicine · 2026Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: In some countries including Singapore, biologic therapies are not routinely available. Instead, oral corticosteroid (OCS) is commonly used for severe asthma management, which could lead to substantial adverse health events. Objective: To estimate the multimorbidity costs in asthma patients from a multi-ethnic Asian population. Methods: We examined national health administrative data (2012-2019) from Singapore. Direct medical costs were summed from costs of hospitalisation, emergency department (ED), specialist care, and public primary care. Prescription data were not available but formed part of public primary care costs. We measured cost per patient-year (PY) in 2023 Singaporean dollars (SGD$1 = US$0.76 = ₤0.60 = €0.69). We performed propensity-score matching on asthma and non-asthma patients, and applied generalised linear models to estimate total and excess costs due to asthma, OCS-related comorbidities, and other comorbidity groups. Results: We identified 19,979 paediatric and 48,237 adult asthma patients (48.2% males, 50.4% Chinese, 13.9% Indian, 26.8% Malay), and matched equal number of non-asthma patients. Paediatric and adult asthma patients respectively incurred $816.3/PY (95% CI: $803.0/PY-$829.5/PY) and $1855.9/PY (95% CI: $1845.0/PY-$1871.0/PY) in total costs. The average ($1610.9/PY [95% CI: $1599.5/PY-$1621.3/PY]) was thrice of non-asthma patients' ($530.4/PY). Excess costs (mean = $927.2/PY) were driven by asthma ($403.0/PY), OCS-related comorbidities ($104.0/PY), other metabolic disease ($116.4/PY), circulatory diseases ($112.9/PY) and non-asthma respiratory conditions ($107.4/PY). All excess cost components increased steadily over the 8-year study period. Conclusion: The burden of asthma multimorbidity in Singapore is severe, with a considerable fraction attributable to OCS-related comorbidities. Policies should aim to reduce excess OCS use and enhance integrated multimorbidity management.
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