A Cost‐Effectiveness Analysis of a Peak Flow‐Based Asthma Education and Self‐Management Plan in a High‐Cost Population

Abstract

Background. Asthma education and action plans (AP) have been recognized as important components in the optimal management of asthma. Studies have differed on the importance of a peak flow-based self-management plans in reducing health care costs and use due to asthma exacerbation. Objective. To analyze the cost-effectiveness of peak flow-based action plans in reducing costs associated with ER visits and hospitalizations due to acute asthma exacerbation in a population of high-risk and high-cost patients, defined as patients with moderate to severe asthma with a history of recent urgent treatment in the ER or hospitalization due to asthma. Methods. A literature review of randomized clinical trials comparing peak flow-based (PFB) action plans, symptom-based (SB) action plans, and usual care/no action plan (NAP) was performed. Probability values regarding the effectiveness of each alternative (as measured by increase/decrease in ER visits and hospitalizations over a 6-month period) were derived. Incremental cost-effectiveness and cost-benefit ratios were calculated for each alternative. Sensitivity analyses were performed. Results. For highrisk and high-cost asthma patients, our analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based self-management plan. The peak flow-based self-management program had an incremental costeffectiveness (C/E) ratio of $ 60.57 per ER visit averted compared to usual care/NAP and a C/E ratio of $31.46 compared to the SB-AP. The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an

Health economics of asthma: assessing the value of asthma interventions

“…Tables 1-4 contain detailed information on each of the economic evaluations organized by their intervention of interest: policy interventions (Table 1), monotherapy controller medications (Table 2), combination controller medications (Table 3), and add-on medications (Table 4). Of the 40 papers that we reviewed, 14 evaluated a policy intervention (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and the other 26 were pharmaceutical comparisons . Of the 14 policy evaluations six considered the economic effects of implementing an education program (22,24,25,28,30,32).…”

“…Of the 40 papers that we reviewed, 14 evaluated a policy intervention (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and the other 26 were pharmaceutical comparisons . Of the 14 policy evaluations six considered the economic effects of implementing an education program (22,24,25,28,30,32). Other studies evaluated management programs (23,26,29,33,35), guidelines (27), and surveillance (31,34).…”

An Economic Evaluation of Asthma Action Plans for Children with Asthma

“…Cost savings have been reported for educational intervention strategies that used peak-flow measurements for self-management compared with a symptom-based self-management plan in adult patients (7). A study evaluating the value of asthma action plans in children reported that 9 of 10 caretakers found the intervention to be useful in managing exacerbations (28).…”

“…Asthma education and action plans are recognized as important elements for the optimal management of asthma and to avoid an acute asthma attack in adults, but evidence is inconclusive regarding their effectiveness and cost-effectiveness in children (7). Studies have demonstrated the short-term benefits of asthma disease management programs, such as improved outcomes, efficient use of resources and decreased costs (8,9).…”

Asthma in Canada: missing the treatment targets

“…How often, if ever, did patients receive education from a certified asthma educator? [13][14][15] How often were the patients with uncontrolled symptoms referred to specialists? For a disease as common and as costly as asthma, it is regrettable that we do not already have a larger list of validated quality-of-care indicators.…”