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            <front>

                <journal-meta>
                                                                <journal-id>akusbd</journal-id>
            <journal-title-group>
                                                                                    <journal-title>Afyon Kocatepe Üniversitesi Sosyal Bilimler Dergisi</journal-title>
            </journal-title-group>
                            <issn pub-type="ppub">1302-1265</issn>
                                        <issn pub-type="epub">2149-4894</issn>
                                                                                            <publisher>
                    <publisher-name>Afyon Kocatepe University</publisher-name>
                </publisher>
                    </journal-meta>
                <article-meta>
                                        <article-id pub-id-type="doi">10.32709/akusosbil.1322364</article-id>
                                                                <article-categories>
                                            <subj-group  xml:lang="en">
                                                            <subject>Health Economy</subject>
                                                            <subject>Health Management</subject>
                                                    </subj-group>
                                            <subj-group  xml:lang="tr">
                                                            <subject>Sağlık Ekonomisi</subject>
                                                            <subject>Sağlık Yönetimi</subject>
                                                    </subj-group>
                                    </article-categories>
                                                                                                                                                        <title-group>
                                                                                                                        <trans-title-group xml:lang="en">
                                    <trans-title>The Global Economic Burden of Asthma Disease: A Systematic Review and Meta-Analysis</trans-title>
                                </trans-title-group>
                                                                                                                                                                                                <article-title>Astım Hastalığının Küresel Ekonomik Yükü: Sistematik Derleme ve Meta Analiz Çalışması</article-title>
                                                                                                    </title-group>
            
                                                    <contrib-group content-type="authors">
                                                                        <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0001-8156-2205</contrib-id>
                                                                <name>
                                    <surname>Alp</surname>
                                    <given-names>Servet</given-names>
                                </name>
                                                                    <aff>BURDUR MEHMET AKİF ERSOY ÜNİVERSİTESİ, İKTİSADİ VE İDARİ BİLİMLER FAKÜLTESİ, SAĞLIK YÖNETİMİ BÖLÜMÜ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-1664-5159</contrib-id>
                                                                <name>
                                    <surname>Ağırbaş</surname>
                                    <given-names>İsmail</given-names>
                                </name>
                                                                    <aff>ANKARA ÜNİVERSİTESİ</aff>
                                                            </contrib>
                                                                                </contrib-group>
                        
                                        <pub-date pub-type="pub" iso-8601-date="20250929">
                    <day>09</day>
                    <month>29</month>
                    <year>2025</year>
                </pub-date>
                                        <volume>27</volume>
                                        <issue>3</issue>
                                        <fpage>938</fpage>
                                        <lpage>962</lpage>
                        
                        <history>
                                    <date date-type="received" iso-8601-date="20230703">
                        <day>07</day>
                        <month>03</month>
                        <year>2023</year>
                    </date>
                                                    <date date-type="accepted" iso-8601-date="20241007">
                        <day>10</day>
                        <month>07</month>
                        <year>2024</year>
                    </date>
                            </history>
                                        <permissions>
                    <copyright-statement>Copyright © 1999, Afyon Kocatepe University Journal of Social Sciences</copyright-statement>
                    <copyright-year>1999</copyright-year>
                    <copyright-holder>Afyon Kocatepe University Journal of Social Sciences</copyright-holder>
                </permissions>
            
                                                                                                <trans-abstract xml:lang="en">
                            <p>Affecting approximately 300 million people worldwide, asthma is a major public health problem causing both premature death and poor quality of life. The disease also imposes a significant economic burden on the health care system and households. The aim of this study was to conduct a meta-analysis based on studies comparing health expenditures between patients with and without asthma and between patients with controlled and uncontrolled asthma to clarify the effect size of health expenditures due to asthma. Another aim of the research is to determine the level of health service utilisation and expenditure in patients with and without asthma and in patients with controlled and uncontrolled asthma. In the study conducted using the PICOS research question strategy, PRISMA protocol principles and flow diagram, 3 different electronic databases (Web of Science (WOS), PubMed and ScienceDirect) were searched with the search formula determined between 06 - 29 April 2023, and 16 studies were included in the analysis as a result of the search. As a result of the analysis, it was found that the effect size and the overall effect size regarding the difference between the health expenditures of patients with asthma and patients without asthma, controlled and uncontrolled asthma patients were quite high. Having (not having) asthma disease, disease level and control level are very important factors on the level of health service utilisation and health expenditures. In order to manage asthma disease, minimise the economic burden of the disease on the health system and households, ensure effectiveness in treatment, and effectively implement the plans and programmes to be prepared for the disease, it is recommended to conduct asthma prevalence surveys throughout the country.</p></trans-abstract>
                                                                                                                                    <abstract><p>Dünya çapında yaklaşık 300 milyon insanı etkileyen astım, hem erken ölüm hem de düşük yaşam kalitesine neden olan önemli bir halk sorunudur. Bununla birlikte hastalık, sağlık sitemi ve hane halkları üzerinde ciddi ekonomik yükü de beraberinde getirmektedir. Bu araştırmanın amacı, astım hastalığı nedeniyle gerçekleşen sağlık harcamalarının etki büyüklüğünü açıklığa kavuşturmak için astımı olan ve olmayan hastalar ve kontrollü ve kontrolsüz astımı olan hastalar arasında sağlık harcamalarını karşılaştıran çalışmalara dayanan bir meta analiz gerçekleştirmektir. Araştırmanın bir diğer amacı astımı olan ve olmayan hastalarda ve kontrollü ve kontrolsüz astım hastalarında sağlık hizmeti kullanım ve harcama düzeyini ortaya koymaktır. PICOS araştırma sorusu stratejisi, PRISMA protokolü ilkeleri ve akış diyagramı kullanılarak gerçekleştirilen çalışmada, 06 - 29 Nisan 2023 tarihleri arasında belirlenen arama formülü ile 3 farklı elektronik veri tabanı (Web of Science (WOS), PubMed ve ScienceDirect) taranmış, yapılan tarama neticesinde 16 araştırma analize dâhil edilmiştir. Yapılan analiz sonucunda; astıma sahip olan hastalar ile olmayan hastalar, kontrollü ve kontrolsüz astım hastalarının sağlık harcamaları arasındaki farka ilişkin etki büyüklüğü ile genel etki büyüklüğünün oldukça yüksek olduğu bulunmuştur. Astım hastalığına sahip olma(ma), hastalık seviyesi ve kontrol düzeyi sağlık hizmeti kullanım düzeyi ve sağlık harcamaları üzerinde oldukça önemli bir etmendir. Astım hastalığını yönetebilmek, hastalığın sağlık sistemi ve hane halkları üzerindeki ekonomik yükünü minimize etmek, tedavide etkinliği sağlayabilmek, hastalığa yönelik hazırlanacak planı ve programları etkin bir şekilde gerçekleştirebilmek için ülke genelinde astım prevalans araştırmaları yapılması önerilmektedir.</p></abstract>
                                                            
            
                                                                                        <kwd-group>
                                                    <kwd>Astım</kwd>
                                                    <kwd>  Hastalık Yükü</kwd>
                                                    <kwd>  Halk Sağlığı</kwd>
                                                    <kwd>  Sağlık Ekonomisi</kwd>
                                                    <kwd>  Sağlık Politikası</kwd>
                                            </kwd-group>
                            
                                                <kwd-group xml:lang="en">
                                                    <kwd>Asthma</kwd>
                                                    <kwd>  Burden of Disease</kwd>
                                                    <kwd>  Public Health</kwd>
                                                    <kwd>  Health Economics</kwd>
                                                    <kwd>  Health Policy</kwd>
                                            </kwd-group>
                                                                                                                                        </article-meta>
    </front>
    <back>
                            <ref-list>
                                    <ref id="ref1">
                        <label>1</label>
                        <mixed-citation publication-type="journal">Aaron, S. D., Boulet, L. P., Reddel, H. K., ve Gershon, A. S. (2018). Underdiagnosis and overdiagnosis of asthma. American journal of respiratory and critical care medicine, 198(8), 1012-1020.</mixed-citation>
                    </ref>
                                    <ref id="ref2">
                        <label>2</label>
                        <mixed-citation publication-type="journal">*Alefan, Q., Nawasrah, A., Almomani, B., ve Al-Issa, E. T. (2022). Direct medical cost of pediatric asthma in Jordan: A cost-of-illness retrospective cohort study. Value in Health Regional Issues, 31, 10-17.</mixed-citation>
                    </ref>
                                    <ref id="ref3">
                        <label>3</label>
                        <mixed-citation publication-type="journal">*Aneeshkumar, S., ve Singh, R. B. (2018). Economic burden of asthma among patients visiting a private hospital in South India. Lung India: Official Organ of Indian Chest Society, 35(4), 312.</mixed-citation>
                    </ref>
                                    <ref id="ref4">
                        <label>4</label>
                        <mixed-citation publication-type="journal">*Barbosa, J. P., Ferreira-Magalhães, M., Sá-Sousa, A., Azevedo, L. F., ve Fonseca, J. A. (2017). Cost of asthma in Portuguese adults: A population-based, cost-of-illness study. Revista Portuguesa de Pneumologia (English Edition), 23(6), 323-330.</mixed-citation>
                    </ref>
                                    <ref id="ref5">
                        <label>5</label>
                        <mixed-citation publication-type="journal">Borenstein, M., Hedges, L. V., Higgins, J.P.T., Rothstein, H.R., 2009. Introduction to MetaAnalysis. John Wiley ve Sons, Ltd, Chichester, UK, UK</mixed-citation>
                    </ref>
                                    <ref id="ref6">
                        <label>6</label>
                        <mixed-citation publication-type="journal">Bousquet, J., Mantzouranis, E., Cruz, A. A., Aït-Khaled, N., Baena-Cagnani, C. E., Bleecker, E. R., ... ve Zuberbier, T. (2010). Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. Journal of Allergy and Clinical Immunology, 126(5), 926-938.</mixed-citation>
                    </ref>
                                    <ref id="ref7">
                        <label>7</label>
                        <mixed-citation publication-type="journal">Chastek, B., Korrer, S., Nagar, S. P., Albers, F., Yancey, S., Ortega, H., ... ve Dalal, A. A. (2016). Economic burden of illness among patients with severe asthma in a managed care setting. Journal of Managed Care ve Specialty Pharmacy, 22(7), 848-861.</mixed-citation>
                    </ref>
                                    <ref id="ref8">
                        <label>8</label>
                        <mixed-citation publication-type="journal">*Chen, W., Safari, A., FitzGerald, J. M., Sin, D. D., Tavakoli, H., ve Sadatsafavi, M. (2019). Economic burden of multimorbidity in patients with severe asthma: a 20-year population-based study. Thorax, 74(12), 1113-1119.</mixed-citation>
                    </ref>
                                    <ref id="ref9">
                        <label>9</label>
                        <mixed-citation publication-type="journal">Cisternas, M. G., Blanc, P. D., Yen, I. H., Katz, P. P., Earnest, G., Eisner, M. D., ... ve Yelin, E. H. (2003). A comprehensive study of the direct and indirect costs of adult asthma. Journal of allergy and clinical immunology, 111(6), 1212-1218.</mixed-citation>
                    </ref>
                                    <ref id="ref10">
                        <label>10</label>
                        <mixed-citation publication-type="journal">Cleophas, J. T., ve Zwinderman, H. A. (2017). Modern meta-analysis: Review and update of methodologies. Springer International Publishing Switzerland.</mixed-citation>
                    </ref>
                                    <ref id="ref11">
                        <label>11</label>
                        <mixed-citation publication-type="journal">Cohen, J. (1988). Statistical power analysis for the behavioral sciences. (2nd Edition) Hillsdale, NJ: Erlbaum.</mixed-citation>
                    </ref>
                                    <ref id="ref12">
                        <label>12</label>
                        <mixed-citation publication-type="journal">Colice, G., Wu, E. Q., Birnbaum, H., Daher, M., Marynchenko, M. B., ve Varghese, S. (2006). Healthcare and workloss costs associated with patients with persistent asthma in a privately insured population. Journal of occupational and environmental medicine, 794-802.</mixed-citation>
                    </ref>
                                    <ref id="ref13">
                        <label>13</label>
                        <mixed-citation publication-type="journal">Çınar, N. (2021). İyi bir sistematik derleme nasıl yazılmalı? Online Türk Sağlık Bilimleri Dergisi, 6(2), 310-314.</mixed-citation>
                    </ref>
                                    <ref id="ref14">
                        <label>14</label>
                        <mixed-citation publication-type="journal">Darba, S., Safaei, N., Mahboub–Ahari, A., Nosratnejad, S., Alizadeh, G., Ameri, H., ve Yousefi, M. (2020). Direct and indirect costs associated with coronary artery (heart) disease in Tabriz, Iran. Risk Management and Healthcare Policy, 969-978.</mixed-citation>
                    </ref>
                                    <ref id="ref15">
                        <label>15</label>
                        <mixed-citation publication-type="journal">*Doz, M., Chouaid, C., Com-Ruelle, L., Calvo, E., Brosa, M., Robert, J., ... ve Detournay, B. (2013). The association between asthma control, health care costs, and quality of life in France and Spain. BMC pulmonary medicine, 13, 1-10.</mixed-citation>
                    </ref>
                                    <ref id="ref16">
                        <label>16</label>
                        <mixed-citation publication-type="journal">Field, A. P., ve Gillett, R. (2010). How to do a meta‐analysis. British Journal of Mathematical and Statistical Psychology, 63(3), 665-694.</mixed-citation>
                    </ref>
                                    <ref id="ref17">
                        <label>17</label>
                        <mixed-citation publication-type="journal">*Finkelstein, E. A., Lau, E., Doble, B., Ong, B., ve Koh, M. S. (2021). Economic burden of asthma in Singapore. BMJ Open Respiratory Research, 8(1), e000654.</mixed-citation>
                    </ref>
                                    <ref id="ref18">
                        <label>18</label>
                        <mixed-citation publication-type="journal">GBD (2019) Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 17; 396(10258):1204-1222. doi: 10.1016/S0140-6736(20)30925-9.</mixed-citation>
                    </ref>
                                    <ref id="ref19">
                        <label>19</label>
                        <mixed-citation publication-type="journal">Glass, G. V., 1976. Primary, Secondary, and Meta-Analysis of Research. Educational Researcher 5, 3–8.
Global Asthma Network. The global asthma report. 2018. Erişim Adresi: http://globalasthmareport.org/ resources/Global_Asthma_Report_ 2018.pdf Erişim Tarihi: 12.04.2023</mixed-citation>
                    </ref>
                                    <ref id="ref20">
                        <label>20</label>
                        <mixed-citation publication-type="journal">Global Burden of Dısease, (2023). Diseases, Injuries, and Impairments.  Erişim Adresi: https://www.thelancet.com/gbd/summaries Erişim Tarihi: 18. 05.2023</mixed-citation>
                    </ref>
                                    <ref id="ref21">
                        <label>21</label>
                        <mixed-citation publication-type="journal">Hekking, P. P. W., Wener, R. R., Amelink, M., Zwinderman, A. H., Bouvy, M. L., ve Bel, E. H. (2015). The prevalence of severe refractory asthma. Journal of Allergy and Clinical Immunology, 135(4), 896-902.</mixed-citation>
                    </ref>
                                    <ref id="ref22">
                        <label>22</label>
                        <mixed-citation publication-type="journal">Higgins, J. P., ve Thompson, S. G. (2002). Quantifying heterogeneity in a meta‐analysis. Statistics in medicine, 21(11), 1539-1558.</mixed-citation>
                    </ref>
                                    <ref id="ref23">
                        <label>23</label>
                        <mixed-citation publication-type="journal">Ivanova, J. I., Bergman, R., Birnbaum, H. G., Colice, G. L., Silverman, R. A., ve McLaurin, K. (2012). Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. Journal of Allergy and Clinical Immunology, 129(5), 1229-1235.</mixed-citation>
                    </ref>
                                    <ref id="ref24">
                        <label>24</label>
                        <mixed-citation publication-type="journal">Lee, L. K., Ramakrishnan, K., Safioti, G., Ariely, R., ve Schatz, M. (2020). Asthma control is associated with economic outcomes, work productivity and health-related quality of life in patients with asthma. BMJ Open Respiratory Research, 7(1), e000534.</mixed-citation>
                    </ref>
                                    <ref id="ref25">
                        <label>25</label>
                        <mixed-citation publication-type="journal">*López-Tiro, J., Contreras-Contreras, A., Rodríguez-Arellano, M. E., ve Costa-Urrutia, P. (2022). Economic burden of severe asthma treatment: A real-life study. World Allergy Organization Journal, 15(7), 100662.</mixed-citation>
                    </ref>
                                    <ref id="ref26">
                        <label>26</label>
                        <mixed-citation publication-type="journal">*Nagase, H., Adachi, M., Matsunaga, K., Yoshida, A., Okoba, T., Hayashi, N., ... ve Tohda, Y. (2020). Prevalence, disease burden, and treatment reality of patients with severe, uncontrolled asthma in Japan. Allergology International, 69(1), 53-60.</mixed-citation>
                    </ref>
                                    <ref id="ref27">
                        <label>27</label>
                        <mixed-citation publication-type="journal">*Ng, B., Sadatsafavi, M., Safari, A., FitzGerald, J. M., ve Johnson, K. M. (2019). Direct costs of overdiagnosed asthma: a longitudinal, population-based cohort study in British Columbia, Canada. BMJ open, 9(11), e031306.</mixed-citation>
                    </ref>
                                    <ref id="ref28">
                        <label>28</label>
                        <mixed-citation publication-type="journal">*Nili, M., Dwibedi, N., Adelman, M., LeMasters, T., Madhavan, S. S., ve Sambamoorthi, U. (2021). Economic burden of asthma-chronic obstructive pulmonary disease overlap among older adults in the United States. COPD: Journal of Chronic Obstructive Pulmonary Disease, 18(3), 357-366.</mixed-citation>
                    </ref>
                                    <ref id="ref29">
                        <label>29</label>
                        <mixed-citation publication-type="journal">Nurmagambetov, T., Kuwahara, R., ve Garbe, P. (2018). The economic burden of asthma in the United States, 2008–2013. Annals of the American Thoracic Society, 15(3), 348-356.</mixed-citation>
                    </ref>
                                    <ref id="ref30">
                        <label>30</label>
                        <mixed-citation publication-type="journal">*Nurmagambetov, T., Kuwahara, R., ve Garbe, P. (2018). The economic burden of asthma in the United States, 2008–2013. Annals of the American Thoracic Society, 15(3), 348-356.</mixed-citation>
                    </ref>
                                    <ref id="ref31">
                        <label>31</label>
                        <mixed-citation publication-type="journal">*Pallegedara, A. (2018). Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka. International journal of health economics and management, 18(3), 301-319.</mixed-citation>
                    </ref>
                                    <ref id="ref32">
                        <label>32</label>
                        <mixed-citation publication-type="journal">Patole, S. (Ed.). (2021). Principles and practice of systematic reviews and meta-analysis. Cham: Springer International Publishing. doi:10.1007/978-3-030-71921-0</mixed-citation>
                    </ref>
                                    <ref id="ref33">
                        <label>33</label>
                        <mixed-citation publication-type="journal">*Reibman, J., Tan, L., Ambrose, C., Chung, Y., Desai, P., Llanos, J. P., ... ve Tkacz, J. (2021). Clinical and economic burden of severe asthma among US patients treated with biologic therapies. Annals of Allergy, Asthma ve Immunology, 127(3), 318-325.</mixed-citation>
                    </ref>
                                    <ref id="ref34">
                        <label>34</label>
                        <mixed-citation publication-type="journal">*Roche, N., Nadif, R., Fabry-Vendrand, C., Pillot, L., Thabut, G., Teissier, C., ... ve Zins, M. (2023). Asthma burden according to treatment steps in the French population-based cohort CONSTANCES. Respiratory Medicine, 206, 107057.</mixed-citation>
                    </ref>
                                    <ref id="ref35">
                        <label>35</label>
                        <mixed-citation publication-type="journal">*Sullivan, P. W., Ghushchyan, V., Navaratnam, P., Friedman, H. S., Kavati, A., Ortiz, B., ve Lanier, B. (2017). The national cost of asthma among school-aged children in the United States. Annals of allergy, asthma ve immunology, 119(3), 246-252.</mixed-citation>
                    </ref>
                                    <ref id="ref36">
                        <label>36</label>
                        <mixed-citation publication-type="journal">Sullivan, S. D., Rasouliyan, L., Russo, P. A., Kamath, T., Chipps, B. E., ve TENOR Study Group. (2007). Extent, patterns, and burden of uncontrolled disease in severe or difficult‐to‐treat asthma. Allergy, 62(2), 126-133.</mixed-citation>
                    </ref>
                                    <ref id="ref37">
                        <label>37</label>
                        <mixed-citation publication-type="journal">Suruki, R. Y., Daugherty, J. B., Boudiaf, N., ve Albers, F. C. (2017). The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC pulmonary medicine, 17(1), 1-11.
Şen, S. ve Yıldırım, İ. (2020). CMA ile meta-analiz uygulamaları. Anı Yayıncılık.</mixed-citation>
                    </ref>
                                    <ref id="ref38">
                        <label>38</label>
                        <mixed-citation publication-type="journal">The Global Asthma Report. (2022). The global asthma report 2022. The International Journal of Tuberculosis and Lung Disease, 26 (1), 1-104.</mixed-citation>
                    </ref>
                                    <ref id="ref39">
                        <label>39</label>
                        <mixed-citation publication-type="journal">Vellopoulou K, Bakakos P, Loukides S, Maniadakis N, Kourlaba G. (2019). The economic burden of asthma in Greece: A cross-sectional study  Appl Health Econ Health Policy. 17:629-40. doi: 10.1007/s40258-019- 00469-4. PubMed PMID: 30997609.</mixed-citation>
                    </ref>
                                    <ref id="ref40">
                        <label>40</label>
                        <mixed-citation publication-type="journal">*Vellopoulou, K., Bakakos, P., Loukides, S., Maniadakis, N. ve Kourlaba, G. (2019). The economic burden of asthma in Greece: a cross-sectional study. Applied Health Economics and Health Policy, 17, 629-640.</mixed-citation>
                    </ref>
                                    <ref id="ref41">
                        <label>41</label>
                        <mixed-citation publication-type="journal">WHO (2023). Asthma. Erişim Adresi: https://www.who.int/news-room/fact-sheets/detail/asthma Erişim Tarihi: 16. 05.2023.</mixed-citation>
                    </ref>
                                    <ref id="ref42">
                        <label>42</label>
                        <mixed-citation publication-type="journal">Wirtz, V. J., Turpin, K., Laing, R. O., Mukiira, C. K., ve Rockers, P. C. (2018). Access to medicines for asthma, diabetes and hypertension in eight counties of Kenya. Tropical Medicine ve International Health, 23(8), 879-885.</mixed-citation>
                    </ref>
                                    <ref id="ref43">
                        <label>43</label>
                        <mixed-citation publication-type="journal">Yaghoubi, M., Adibi, A., Safari, A., FitzGerald, J. M., ve Sadatsafavi, M. (2019). The projected economic and health burden of uncontrolled asthma in the United States. American journal of respiratory and critical care medicine, 200(9), 1102-1112.</mixed-citation>
                    </ref>
                            </ref-list>
                    </back>
    </article>
