Cost-effectiveness analysis of a state funded programme for control of severe asthma (original) (raw)
Related papers
Cost-effectiveness of asthma therapy
Official journal of the South African Academy of Family Practice/Primary Care
An important management strategy in asthma is the application of a cost-effectiveness review to the selected management principles. Efficacy, in the clinical trial setting, is the first determinant of effectiveness. However, in comparing the cost- effectiveness of two or more therapeutic strategies or drugs the determinants of cost-effectiveness may require more than the simple comparison of Rand value and clinical efficacy end-points. The Rand value of a successful outcome is vital. One of the main goals of long-term asthma management is to avoid asthma-related hospital admissions. An effective asthma education programme can resolve most, if not all of the shortcomings in asthma care. In addition, adherence to guideline recommendations would result in a a decrease in unnecessary and costly (cost-ineffective) therapies. Many asthmatics in South Africa are not being treated according to local or international guideline recommendations and lastly adherence is a serious problem in asth...
Economic Evaluation of Enhanced Asthma Management: A Systematic Review
Value in Health, 2013
Objectives: To evaluate and compare full economic evaluation studies on the cost-effectiveness of enhanced asthma management (either as an adjunct to usual care or alone) vs. usual care alone. Methods: Online databases were searched for published journal articles in English language from year 1990 to 2012, using the search terms '"asthma" AND ("intervene" OR "manage") AND ("pharmacoeconomics" OR "economic evaluation" OR "cost effectiveness" OR "cost benefit" OR "cost utility")'. Hand search was done for local publishing. Only studies with full economic evaluation on enhanced management were included (cost consequences (CC), cost effectiveness (CE), cost benefit (CB), or cost utility (CU) analysis). Data were extracted and assessed for the quality of its economic evaluation design and evidence sources. Results: A total of 49 studies were included. There were 3 types of intervention for enhanced asthma management: education, environmental control, and self-management. The most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals. In general, the studies had a fair quality of economic evaluation with a mean QHES score of 73.7 (SD=9.7), and had good quality of evidence sources. Conclusion: Despite the overall fair quality of economic evaluations but good quality of evidence sources for all data components, this review showed that the delivered enhanced asthma managements, whether as single or mixed modes, were overall effective and cost-reducing. Whilst the availability and accessibility are an equally important factor to consider, the sustainability of the costeffective management has to be further investigated using a longer time horizon especially for chronic diseases such as asthma.
Costs of asthma are correlated with severity: a 1-yr prospective study
European Respiratory Journal, 2001
Asthma prevalence is increasing and asthma-related costs are likely to increase, but few studies have analysed the relationship of asthma costs and severity. The impact of severity on costs was quantified in a cohort of 318 asthmatic patients followed up prospectively for 1 yr. Patients presenting with a broad range of severity of the disease (intermittent, mild persistent, moderate persistent, severe persistent) were recruited by chest physicians throughout France and treated for 1 yr according to customary clinical practice and following international guidelines. Severity, direct and indirect costs, and quality of life (QoL) were assessed. A multivariate analysis was conducted to relate factors contributing to the costs measured. Mean direct costs for goods and services excluding hospitalization, numbers of consultations, supplementary examinations, and the use and cost of bronchodilators and corticosteroids, indirect costs of days lost from work, and adverse QoL parameters all increased significantly with increasing severity. This also applied to mean age, body weight, asthma duration, depression of forced expiratory volume in one second, and inhaled corticosteroid posology in the 234 patients completing the study. There was a significant relationship (r=0.614, pv0.001) between direct costs (hospitalization and cures were excluded) and three domains of the QoL questionnaire (mobility, pain and energy). Overall costs of asthma (including individual direct costs, indirect costs, and intangible quality of life costs) are clearly related to severity. This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving "real-world" treatment and followed-up prospectively for 1 yr. It allowed severity to be accurately related to direct, indirect and intangible costs of asthma. Quality of life explained a significant part of these costs.
A cost-of-illness study estimating the direct cost per asthma exacerbation in Turkey
Respiratory Medicine, 2011
Objective: To calculate direct cost per asthma exacerbation at tertiary healthcare centers across Turkey. Methods: A total of 294 persistent asthma patients (mean age: 50.4 AE 15.1 years) were included in this retrospective study upon admission with an acute asthma attack. Direct costs including drug treatment, non-drug treatment, healthcare resource utilization, emergency care, tests and consultations were calculated per asthma attack in relation to asthma attack severity. Results: The asthma attack was moderate in 57.5% of the patients. Direct cost was V214.9 (95% CI: 183.9; 245.8) per attack. The cost of severe attack V308.2 (95% CI: 258.2; 358.2)] was significantly higher than moderate [V172.6 (95% CI: 155.1; 190.2)] and mild [V128.6 (95% CI: 102.6; 154.7) attacks. It was also significantly higher for inpatient follow-up [V257.7 (95% CI: 220.4; 295)] vs. outpatient follow-up [V54.5 (95% CI: 47; 62; p < 0.001)] and uncontrolled asthma [V288.2 (95% CI: 216.7; 359.6)] vs. controlled [V128.9 (95% CI: 92.1; 165.8); p < 0.01] asthma. Conclusion: Health policies targeting achievement of better asthma control and lower disease severity during the stable periods of the disease as well as appropriate hospitalization of patients and rational prescribing of drugs will play crucial role in the reduction of economic burden of asthma for the patient and the society.
European Respiratory Journal, 1996
At present, asthma represents a substantial burden on health care resources in all countries so far studied. The costs of asthma are largely due to uncontrolled disease, and are likely to rise as its prevalence and severity increase. Costs could be significantly reduced if disease control is improved. A large proportion of the total cost of illness is derived from treating the consequences of poor asthma control-direct costs, such as emergency room use and hospitalizations. Indirect costs, which include time off work or school and early retirement, are incurred when the disease is not fully controlled and becomes severe enough to have an effect on daily life. In addition, quality of life assessments show that asthma has a significant socioeconomic impact, not only on the patients themselves, but on the whole family. Underuse of prescribed therapy, which includes poor compliance, significantly contributes towards the poor control of asthma. The consequences of poor compliance in asthma include increased morbidity and sometimes mortality, and increased health care expenditure. To improve asthma management, international guidelines have been introduced which recommend an increase in the use of prophylactic therapy. The resulting improvements in the control of asthma will reduce the number of hospitalizations associated with asthma, and may ultimately produce a shift within direct costs, with subsequent reductions in indirect costs. In addition, costs may be reduced by improving therapeutic interventions and through effective patient education programmes. This paper reviews current literature on the costs of asthma to assess how effectively money is spent and, by estimating the proportion of the cost attributable to uncontrolled disease, will identify where financial savings might be made.
Archivos de bronconeumología, 2011
Few studies have comprehensively assessed the evolution asthma disease in recent years. To determine changes in morbidity, lung function and quality of life and to establish the impact in terms of cost in a cohort of patients with asthma. Prospective, descriptive and realistic study that included 220 asthma patients evaluated 10 years after their inclusion (1994-2004). For all the patients, data for symptoms, lung function, quality of life and financial cost were collected. There was a decrease in the frequency of health service visits, including: emergency room visits for asthma exacerbations, 0.3 (0.9) versus 0.6 (1) visits per patient per year (P=.003); a reduction in the severity of the disease, with a greater proportion of patients with mild asthma, 121 (54.8%) versus 94 (42.7%) (P=.001); a decrease (improvement in quality of life) in the total SGRQ, 30.1 (16.5) versus 37 (19.6) (P<.001); and reduced total costs, 1,464€ (3,415.8) compared to 2,267€ (4.174) per patient/year (...
Asthma-Related Costs Relative to Severity and Control in General Practice
Pediatric Asthma, Allergy & Immunology, 2005
Limited data are available about costs of asthma care by general practitioners (GPs) in France. This study evaluated asthma care costs of children treated by GPs, and the relationship between cost and asthma control across different degrees of asthma severity. We conducted a retrospective longitudinal observational study based on a computerized prescription database of GPs supplemented with a cross-sectional survey of children aged 6-16 with persistent asthma (GINA step Ն2). Retrospective data on asthma-related medical resource utilization (MRU) were collected for a 12-month study period. MRU included antiasthma medications, visits to GPs, visits to emergency rooms, and hospitalizations. Asthma control was evaluated from recent asthma symptoms, whereas severity was defined by the average dose of inhaled corticosteroids prescribed during a preindex period. Univariate and multivariate analyses were used to evaluate relationships between MRU and other variables of interest. Among 261 children with completed surveys, the proportion of total MRU cost due to GP visits, medications, and emergency room visits was 20%, 30%, and 2%, respectively. Although hospitalizations accounted for almost 50% of total costs, only 17 children (6.5%) were hospitalized during the study period. In children with severe asthma, total MRU cost was significantly higher when control of asthma was poor, compared with moderate and good levels of asthma control (p ؍ 0.004). However, no similar association emerged in children with low and moderate severity. A minority of children with high-cost medical use accounted for a significant part of total expenditures. Total MRU costs varied according to level of control in children with high disease severity.
Structuring and validating a cost-effectiveness model of primary asthma prevention amongst children
BMC Medical Research Methodology, 2011
Background: Given the rising number of asthma cases and the increasing costs of health care, prevention may be the best cure. Decisions regarding the implementation of prevention programmes in general and choosing between unifaceted and multifaceted strategies in particular are urgently needed. Existing trials on the primary prevention of asthma are, however, insufficient on their own to inform the decision of stakeholders regarding the cost-effectiveness of such prevention strategies. Decision analytic modelling synthesises available data for the cost-effectiveness evaluation of strategies in an explicit manner. Published reports on model development should provide the detail and transparency required to increase the acceptability of cost-effectiveness modelling. But, detail on the explicit steps and the involvement of experts in structuring a model is often unevenly reported. In this paper, we describe a procedure to structure and validate a model for the primary prevention of asthma in children.
Evaluation of the Treatment Costs of Asthma Exacerbations in Outpatients
Acta poloniae pharmaceutica
The aim of this study was to assess the correlation between the costs of controlled and uncontrolled asthma therapy in outpatients care. To determine the efficacy of the medicinal care there was performed a retrospective study on a group of 150 patients. Thirty eight patients have been enrolled to study group. Drug costs were estimated on the basis of documentation of patients. The assessment takes into account the cost of the retail price of drugs, the cost of diagnostic tests and outpatient care. Evaluation of the costs of treatment of patients was performed from a societal perspective. In the study there was calculated the value of the daily, monthly and annual treatment of the patient depending on the degree of asthma control. There was analyzed the frequency of reception of certain preparations in the study group. It was compared the annual cost of therapy for the given preparation in both examined groups. The total annual costs of therapy in patients with controlled and uncont...
Asthma control cost-utility randomized trial evaluation (ACCURATE): the goals of asthma treatment
BMC Pulmonary Medicine, 2011
Background: Despite the availability of effective therapies, asthma remains a source of significant morbidity and use of health care resources. The central research question of the ACCURATE trial is whether maximal doses of (combination) therapy should be used for long periods in an attempt to achieve complete control of all features of asthma. An additional question is whether patients and society value the potential incremental benefit, if any, sufficiently to concur with such a treatment approach. We assessed patient preferences and cost-effectiveness of three treatment strategies aimed at achieving different levels of clinical control: 1. sufficiently controlled asthma 2. strictly controlled asthma 3. strictly controlled asthma based on exhaled nitric oxide as an additional disease marker