Health Care Spending on Respiratory Diseases in the United States, 1996–2016

Abstract Rationale Respiratory conditions account for a large proportion of health care spending in the United States. A full characterization of spending across multiple conditions and over time has not been performed. Objectives To estimate health care spending in the United States for 11 respiratory conditions from 1996 to 2016, providing detailed trends and an evaluation of factors associated with spending growth. Methods We extracted data from the Institute of Health Metrics and Evaluation’s Disease Expenditure Project Database, producing annual estimates in spending for 38 age and sex groups, 7 types of care, and 3 payer types. We performed a decomposition analysis to estimate the change in spending associated with changes in each of five factors (population growth, population aging, disease prevalence, service usage, and service price and intensity). Measurements and Main Results Total spending across all respiratory conditions in 2016 was 170. 8 billion (95% confidence interval CI, 164. 2–179. 2 billion), increasing by 71. 7 billion (95% CI, 63. 2–80. 8 billion) from 1996. The respiratory conditions with the highest spending in 2016 were asthma and chronic obstructive pulmonary disease, contributing 35. 5 billion (95% CI, 32. 4–38. 2 billion) and 34. 3 billion (95% CI, 31. 5–37. 3 billion), respectively. Increasing service price and intensity were associated with 81. 4% (95% CI, 70. 3–93. 0%) growth from 1996 to 2016. Conclusions U. S. spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. Our findings suggest that service price and intensity, particularly for pharmaceuticals, should be a key focus of attention for policymakers seeking to reduce health care spending growth.