Projected 20-Year Burden of Asthma in Singapore: Data from Population Real World Registry

<bold>Introduction:</bold> Singapore experiences high burden of asthma due to gaps in asthma management. <bold>Objectives:</bold> To project the future 20-year humanistic and economic burden of asthma in Singapore under guideline-based medication use. <bold>Methods:</bold> A probabilistic model was used to project national asthma costs and quality-adjusted life years (QALYs) between 2024-2043 based on population growth, ageing, asthma prevalence and control, inhaled corticosteroids (ICS) adherence and short-acting beta agonist (SABA) use. Parameters were obtained from meta-analysis and regression analyses of population-based SingHealth Real World Registry. <bold>Results:</bold> The projected 20-year direct and indirect costs total $4.7 (95% CI: 4.2-5.3) billion and $3.3 (95% CI: 3.0-3.8) billion in children (uncontrolled asthma (UCA) accounted for 68% and 65%) and $6.3 (95% CI: 5.9-6.7) billion and $28.3 (95%CI: 26.6-30.1) billion in adults (UCA: 53% and 36%); QALYs lost total 0.3 (95% CI: 0.3-0.3) million (UCA: 27%), with estimated mean ICS medication possession ratio (MPR)=0.55, SABA use=2.1 and 5 can/year in children and adults. If all asthmatics achieve adherence (MPR=0.8) and appropriate SABA use (1 can/year), 20-year direct and indirect costs would reduce by $6.0 (95% CI: 5.8-6.2) million and $3.7 (95% CI: 3.6-3.8) million in children (UCA burden: 64% and 61%) and $11.9 (95% CI: 11.2-12.7) million and $7.7 (95% CI: 5.0-10.5) million in adults (UCA: 47% and 33%); QALYs lost would fall by 125 (95% CI: 114-137) (UCA: 23%). <bold>Conclusions:</bold> The projected burden of asthma in Singapore is substantial if current practices continue without population-level improvement. Policy changes are imperative to address the increasing burden of asthma.