Economic Evaluation of Enhanced Asthma Management: A Systematic Review

Yong, Yee Vern; Shafie, A.A.

doi:10.1016/j.jval.2013.08.312

Cited by 4 publications

(6 citation statements)

References 65 publications

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“…Review of full-text articles and associated discussion led to group consensus and ultimate inclusion/exclusion. The following inclusion criteria were applied to studies (12): Included a clinical intervention comparison for patients with TTAIncluded any one of the following types of economic evaluation: Cost-consequence analysis (CCA), involving a way of reporting cost and an array of outcomes in a separate and disaggregated way so that no incremental ratios are involvedCost-effectiveness analysis (CEA), involving incremental analysis between the calculated differences in costs and outcomesCost-benefit analysis (CBA), which values both measured health and non-health outcomes in monetary unitsCost-utility analysis (CUA), involving utilities, quality-adjusted life years (QALY), or their variants as the measured outcomesCost-identification analysis (CIA), in which a cost comparison is made without the inclusion of a comparison of health outcomes Published within the aforementioned timeline …”

Section: Methodsmentioning

confidence: 99%

“…Its major limitation is its multi-topic items in a single criterion (i.e., multiple items within a single item share a single weight). For this review, the QHES scoring system was modified without changing the original weights to overcome this drawback in accordance with previous use (12). Multi-topic questions were assigned sub-weights per item but still summed to the original weight.…”

Section: Methodsmentioning

confidence: 99%

“…After determining the total scores and converting to a percentage, a total QHES score of 75 to 100 indicated “high quality,” 50 to 74 indicated “fair quality,” 25 to 49 indicated “poor quality,” and 0 to 24 indicated “extremely poor quality” (12). Following the rating for economic evaluation with QHES, methodological quality of included studies was rated as described below.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

et al. 2016

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Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report’s purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA. The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight-bearing and total-contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

et al. 2016

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“…Yong and Shafie 43 have published a systematic review that looked more broadly at non-pharmacological interventions aiming to improve asthma management. The interventions included by Yong and Shafie varied from educational and self-management interventions to environmental interventions.…”

Section: The Trial In Context: Other Studies and Differences In Resultsmentioning

confidence: 99%

PLEASANT: Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term – a cluster randomised controlled trial and economic evaluation

Julious

Horspool

Davis

et al. 2016

Health Technol Assess

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BackgroundAsthma episodes and deaths are known to be seasonal. A number of reports have shown peaks in asthma episodes in school-aged children associated with the return to school following the summer vacation. A fall in prescription collection in the month of August has been observed, and was associated with an increase in the number of unscheduled contacts after the return to school in September.ObjectiveThe primary objective of the study was to assess whether or not a NHS-delivered public health intervention reduces the September peak in unscheduled medical contacts.DesignCluster randomised trial, with the unit of randomisation being 142 NHS general practices, and trial-based economic evaluation.SettingPrimary care.InterventionA letter sent (n = 70 practices) in July from their general practitioner (GP) to parents/carers of school-aged children with asthma to remind them of the importance of taking their medication, and to ensure that they have sufficient medication prior to the start of the new school year in September. The control group received usual care.Main outcome measuresThe primary outcome measure was the proportion of children aged 5–16 years who had an unscheduled medical contact in September 2013. Supporting end points included the proportion of children who collected prescriptions in August 2013 and unscheduled contacts through the following 12 months. Economic end points were quality-adjusted life-years (QALYs) gained and costs from an NHS and Personal Social Services perspective.ResultsThere is no evidence of effect in terms of unscheduled contacts in September. Among children aged 5–16 years, the odds ratio (OR) was 1.09 [95% confidence interval (CI) 0.96 to 1.25] against the intervention. The intervention did increase the proportion of children collecting a prescription in August (OR 1.43, 95% CI 1.24 to 1.64) as well as scheduled contacts in the same month (OR 1.13, 95% CI 0.84 to 1.52). For the wider time intervals (September–December 2013 and September–August 2014), there is weak evidence of the intervention reducing unscheduled contacts. The intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children collecting prescriptions in August as well as having scheduled contacts in the same month. These unscheduled contacts in September could be a result of the intervention, as GPs may have wanted to see patients before issuing a prescription. The economic analysis estimated a high probability that the intervention was cost-saving, for baseline-adjusted costs, across both base-case and sensitivity analyses. There was no increase in QALYs.LimitationThe use of routine data led to uncertainty in the coding of medical contacts. The uncertainty was mitigated by advice from a GP adjudication panel.ConclusionsThe intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children both collecting prescriptions and having scheduled contacts in August. After September there is weak evidence in favour of the intervention. The intervention had a favourable impact on costs but did not demonstrate any impact on QALYs. The results of the trial indicate that further work is required on assessing and understanding adherence, both in terms of using routine data to make quantitative assessments, and through additional qualitative interviews with key stakeholders such as practice nurses, GPs and a wider group of children with asthma.Trial registrationCurrent Controlled Trials ISRCTN03000938.Funding detailsThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 93. See the HTA programme website for further project information.

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“…It is known to improve quality of life and asthma control in adults with asthma [7, 8], and to also be cost-effective [9]. In addition to giving patients factual and unbiased information, patient education tailors teaching to the patients’ needs and requires identification and acknowledgment of their concerns, as part of a patient-centered care approach [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial

et al. 2017

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BackgroundNot providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma.MethodsA parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score –37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models.ResultsFifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9–23.2] to 25.1 [23.1–27.0] in the education + DA group (P = 0.0002) and from 24.0 [22.3–25.7] to 26.0 [24.0–28.0] in the education group (P = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups.ConclusionsEducation improved knowledge, decisional conflict, and asthma control whether the DA was added or not.

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Economic Evaluation of Enhanced Asthma Management: A Systematic Review

Cited by 4 publications

References 65 publications

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

PLEASANT: Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term – a cluster randomised controlled trial and economic evaluation

Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial

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