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.

Benefits at 3 yrs of an asthma education programme coupled with regular reinforcement

“…A number of previous studies, including a controlled trial conducted by the present authors9 group [15], have demonstrated that training in asthma selfmanagement that involves self-monitoring by either PEFR or symptoms appears to improve health outcomes for adults with asthma, at least in the short term [2][3][4][5][6][7][8][9][10][11][12][13][14][16][17][18][19][20][21][22][23][24][25][26][27]. Training programmes which enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management [25].…”

Cost-effectiveness of self-management in asthmatics: a 1-yr follow-up randomized, controlled trial

“…3). This observation seems common when considering cost evaluations for asthma [13,14,32,33]. For example, within the USA, 10% of asthmatic patients accounted for 44% of the total medical costs of treating the condition [34].…”

“…However, previous costeffectiveness assessments after asthma education are rare and of limited applicability to clinical practice. KAUPPINEN et al [13] reported an improvement in the forced expiratory volume in one second (FEV1) at higher costs without performing a sensitivity analysis and NERI et al [14] described the cost of one day of admission being prevented.…”

Validación de un cuestionario de conocimientos acerca del asma entre padres o tutores de niños asmáticos

“…Es decir, debe promover la adquisición de habilidades que permitan a los niños y/o a sus padres prevenir o manejar adecuadamente las crisis asmáticas 6,7 . Sin embargo, para atribuir los cambios en el conocimiento acerca del asma a la intervención educativa en lugar de atribuirlos a un error en la medición, es necesario contar con un instrumento de medición válido, fiable y sensible al cambio 8 .…”