Economic analysis of two structured treatment and teaching programs on asthma

Abstract

The aims of the present study were as follows: 1) to evaluate the medical outcomes of two treatment and educational asthma programs 2) to determine by cost-analysis both cost and economic outcome of the programs 3) to perform a cost-benefit analysis (determining the net cost-benefit) and a cost-effectiveness analysis (determining the cost per unit of effect and the incremental cost-effectiveness ratio) from the perspective of health program policy makers (HPP; indirect costs, i.e., loss of productivity, excluded) and of society as a whole (SaW, all costs included). Patients were randomly assigned to a complete (CP; n = 32) or reduced (RP; n = 33) program: the RP group received a reduced education (self-reading of an educational booklet on asthma), while the CP group attended an "asthma school", consisting of six lessons based on the same booklet and including educational videotapes. Both programs included peak-flow monitoring and treatment according to international guidelines, and follow-up. The outcome variables (asthma attacks, urgent medical examinations, admission days, working days lost) did not differ significantly between CP and RP. Morbidity savings were $1894.70 (CP) and $1697.80 (RP) according to SaW, and $1349.50 and $1301.80, respectively, according to HPP. The net cost-benefit was $1181.50 for CP and $1028.00 for RP, and the cost-benefit ratio per dollar spent was 1:2.6 for CP and 1:2.5 for RP, according to SaW. One day of admission prevented had a cost of $110.20 (CP) and $94.10 (RP). CP gave slightly better results and was slightly more cost-effective than RP in improving patients' welfare. It cannot be excluded that the retrospective analysis used to determine baseline costs might have inflated differences for both groups. Sensitivity analysis was slightly in favor of RP when the outcome variables were tested at their upper and lower 95% CI.

Measuring the benefits of health promotion programmes: Application of the contingent valuation method

“…Cost-effectiveness analysis has been the most common form of economic evaluation used to evaluate health promotion programmes [17]. Intermediate outcomes such as behaviour change, changes in knowledge, attitudes, and practice [18]; health service utilisation or preference for treatment options [19,20]; or the level of participation in treatment decision-making [21], are often used. This limits the comparability of cost-effectiveness results from health promotion programmes with that of other interventions.…”

The limited incorporation of economic analyses in clinical practice guidelines

“…After excluding duplicates, letters, editorials, and reviews and classifying by medical condition on the basis of the title, there were a total of 2,121 candidate practice guidelines and 2,377 candidate economic analyses. The medical conditions with the most candidate practice guidelines and at least 10 candidate economic analyses for each category were acute myocardial infarction, 21–56 asthma, 57–90 smoking cessation, 91–113 colorectal cancer, 114–140 and breast cancer. 141–166 The second literature search with the addition of each condition's MESH heading resulted in the identification of additional guidelines and economic analyses.…”

Economic Evaluation of Enhanced Asthma Management: A Systematic Review

“…The majority of the studies originated from the United States of America7,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54, followed by Europe8,55,56,57,58,59,60,61,62,63,64,65,66,67, Asia68-72, and Australia 73,7475,76. There was one economic evaluation concerning enhanced asthma management30 done in 1991, and at least one between 1994 and 2012.…”

“…There were 5 CBA studies that reported a positive net benefit for every dollar spent 35,60,62,63,66. In addition to the excluded non-full CBA study29, there was another study that also did not value the health outcomes in monetary units 40.…”

“…The maximum and minimum scores were 94.746 and 59.068 respectively. There were 32 (60%) economic evaluations that scored within 50-74 (fair quality)31-39,42,44,48-50,52-54,57-61,66-68,70,717273,74 and the remaining 21 (40%) evaluations scored within 75-100 (high quality) 7,8,30,40,41,43,45-47,51,55,56,62,63,64,65,69,75,76. There was no obvious pattern of the QHES scores across the years 1991 to 2012 (Online Appendix).…”