Estimating work-related indirect costs in allergic rhinitis and asthma using a daily combined symptom-medication score: a MASK-air® study in collaboration with the EAACI Methodology Committee

Vieira RJ, di Bona D, Bognanni A et al. J Allergy Clin Immunol Pract. 2026 Jun 11:S2213-2198(26)00497-6. doi: 10.1016/j.jaip.2026.05.035. 

Highlights

• What is already known about this topic? Allergic rhinitis and asthma have a relevant impact on work productivity, particularly in terms of presenteeism. However, this impact is difficult to quantify in daily clinical practice.
• What does this article add to our knowledge? This study demonstrates that a visual analogue scale can evaluate the impact of allergic symptoms on work productivity. In addition, it estimates the costs resulting from work productivity losses due to poor symptom control.
• How does this study impact current management guidelines? Based on the approach described in this study, practitioners can easily estimate work productivity losses of their patients due to poor rhinitis and asthma control. Results of this study can inform cost-effectiveness studies.

Abstract
Background
Allergic rhinitis and asthma can impair work productivity.

Objective
To validate a daily work productivity visual analog scale (VAS work), comparing it with the Work Productivity and Activity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific (WPAI+CIQ:AS). We also aimed to quantify how allergy control relates to work impairment and indirect costs.

Methods
We conducted a cross-sectional study using data from the MASK-air® app. Patients recorded daily VAS and weekly WPAI+CIQ:AS responses. We calculated correlations between VAS work and WPAI+CIQ:AS outcomes. Mixed-effects regression models assessed associations between disease control, measured by the Combined Symptom-Medication Score (CSMS) and the electronic daily asthma control score (e-DASTHMA), and VAS work. Indirect costs were estimated using the human capital approach, applying VAS-based productivity losses to country-specific wage distributions.

Daily estimated indirect costs associated with well-,
partially-, and poorly controlled disease as assessed
by the Combined Symptoms-Medication Score

Results
VAS work correlated strongly with the WPAI+CIQ:AS, with Spearman coefficients ≥0.70 for total work impairment and presenteeism. Each 1-point increase in CSMS and e-DASTHMA was associated with mean 0.97 and 0.79-point increases in VAS work, respectively. In poorly controlled days, the estimated daily indirect cost based on CSMS ranged from 12.50 US$ PPP (P25–P75=5.60–26.70) in Brazil to 129.90 US$ PPP (P25–P75=80.40–199.40) in Iceland. Based on e-DASTHMA, daily estimates ranged from 9.30 US$ PPP (P25–P75=3.70–21.50) in Brazil to 101.90 US$ PPP (P25–P75=51.20–172.40) in Iceland.

Conclusion
VAS work is a valid simple daily measure of work impairment due to rhinitis and asthma. CSMS and e-DASTHMA can be used to estimate productivity losses attributable to poor disease control.

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