TABLE 3.

Direct impacts generated on NHS costs, GHG emissions and patient travel costs, and indirect impacts on HRQoL and productivity loss at work

	Asthma pathway stage
	Diagnosis stage	Maintenance treatment	Uncontrolled asthma treatment
Direct impacts #
NHS costs	HCP and tests	GP/nurse time and tests, controller inhaler, other medications	Secondary care usage (including ambulance, calls to emergency 999, hospital admissions), reliever inhaler and OCS tablets
GHG emissions	Running facilities, travel	Inhaler usage, running facilities, travel	Reliever inhaler usage and OCS tablets usage
Patient travel costs	Travelling to and from appointments
Indirect impacts for uncontrolled asthma ¶
HRQoL loss	Morbidity: loss of QALY due to living with asthma, non-adherence to treatment and exacerbations		Mortality: loss of QALY due to years of life lost
Productivity loss (at work)	Unemployment due to inability to work	Lower hourly wage due to inability to travel long distances for better employment conditions	Higher absenteeism due to time off work related to sickness and attending appointments

GHG: greenhouse gas; GP: general practitioner; HCP: healthcare practioner; HRQoL: health-related quality of life; NHS: National Health Service; OCS: oral corticosteroids; QALY: quality-adjusted life years. ^#: direct impacts were due to the main activities undertaken by patients under each asthma pathway stage. The activities could be grouped into three main categories: primary care (HCP visits for diagnosis, unplanned HCP visits and asthma reviews), secondary care (calls to 999, ambulance, accident and emergency admissions and hospitalisations (day stays and longer stays)) and pharmacological treatment (controller and reliever inhalers and add-on treatments); ^¶: indirect impacts were considered only for patients with uncontrolled asthma and were assumed to be independent of the asthma pathway stage.