Cost-effectiveness of implementing objective diagnostic verification of asthma in the United States

Abstract

Background: Asthma diagnosis in the community is often made without objective testing. Objective: The aim of this study was to evaluate the cost-effectiveness of implementing a stepwise objective diagnostic verification algorithm among patients with community-diagnosed asthma in the United States. Methods: We developed a probabilistic time-in-state cohort model that compared a stepwise asthma verification algorithm on the basis of spirometry testing and a methacholine challenge test against the current standard of care over 20 years. Model input parameters were informed from the literature and with original data analyses when required. The target population was US adults (> _15 years old) with physician-diagnosed asthma. The final outcomes were costs (in 2018 dollars) and quality-adjusted life years (QALYs), discounted at 3% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results. Results: In a simulated cohort of 10,000 adults with diagnosed asthma, the stepwise algorithm resulted in removal of the diagnosis of 3,366. This was projected to be associated with savings of $36.26 million in direct costs and a gain of 4,049.28 QALYs over 20 years. Extrapolating these results to the US population indicated an undiscounted potential savings of $56.48 billion over 20 years. The results were robust against alternative assumptions and plausible changes in values of input parameters. Conclusion: Implementation of a simple diagnostic testing algorithm to verify asthma diagnosis might result in substantial savings and improvement in patients' quality of life.

The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities

“…Aaron et al reported that nearly one-third of patients with physician-diagnosed asthma could not be verified when using objective testing such as peak flow, spirometry, and bronchoprovocation [7]. Several studies have demonstrated that the overall cost of misdiagnosing asthma can be substantial [2,[18][19]. While healthcare cost varies by systems and locations, one study noted that the average annual cost per person was $3,266 [2].…”

“…Yaghoubi and colleagues extrapolated their findings to the US populations for a potential savings of over $56 billion over 20 years [19]. Even in smaller cohorts, such as the population of the JDACs, improper asthma diagnoses can add unnecessary burdens to the overall cost of incarceration and divert funding and resources from other essential services.…”

“…Implementing a diagnostic testing algorithm to verify asthma diagnosis may result in substantial savings and improvement in patients' quality of life [19]. Additionally, an educational intervention can significantly improve patient asthma outcomes, resulting in fewer unscheduled visits and hospitalizations [21][22].…”

Development and Validation of an Asthma Policy Model for Canada: Lifetime Exposures and Asthma outcomes Projection (LEAP)

“…Direct annual costs due to having asthma by the control levels and having exacerbation by the severity levels were extracted from Yaghoubi et al (2020). The costs were converted from 2018 USD to 2023 CAD using historical inflation (1 USD in 2018 = 1.22 USD in 2023; 1 USD = 1.36 CAD in 2023).…”

“…Aldington and Beasley ( 2007), Yaghoubi et al (2020), Einarson et al (2015) Direct annual costs due to asthma control Let 𝑐 ) 3 be the direct annual costs due to asthma control level 𝑗. Then the total cost due to asthma control is given by: ∑ 𝑐 ) 3 ) 𝐶𝑇 ) .…”