Long-term (3-year) economic evaluation of intensive patient education for self-management during the first year in new asthmatics

Abstract

Patient education and self-management programmes have proved effective in many studies with short follow-up periods. We studied the 3-year cost-effectiveness of an intensive programme of patient education and supervision for self-management. The study consisted of 162 consecutive newly diagnosed asthmatics who were randomized either into an intervention group (IG) receiving intensive patient education and supervision for self-management at an outpatient clinic during the first year, or a control group (CG) receiving conventional education at the baseline visits only. Both groups had 2 additional years of follow-up. Lung functions and health-related quality of life (HRQOL) were measured. Extra direct and indirect costs were recorded. At 3 years the differences in forced expiratory volume in 1 s (FEV1) and in peak expiratory flow (PEF) were significantly better in the IG being in (% predicted) respectively 5.3 (95% CI 0.6-10.0) and 4.4 (95% CI 0.1-8.7), (P < 0.05). The airway responsiveness (PD15) did not differ significantly, but the improvement from baseline to 3 years was significantly greater in the IG, being 0.40 dose steps (95% CI 0.05-0.75) (P < 0.05). HRQOL scores did not differ significantly. The risk for sickness day was less in the IG with a RR of 0.6 (95% CI 0.50-0.69) (P = 0.000) and among patients who used the PEF meter. The compliance was similar in both groups when measured by the PEF-based self-management. There was no statistically significant difference in costs, although there was a consistent tendency for lower costs in the intensive programme. The intensive programme was more effective in terms of FEV1, PEF and improvement in PD15 and equally effective in terms of other lung functions and HRQOL, but there was no clear difference in the costs.

The Effects of Asthma Education on Asthma Knowledge and Health-Related Quality of Life in Taiwanese Asthma Patients

“…This finding suggests that education programs, such as the one used in this study, can increase patient knowledge about asthma. As in several previous studies (Clark & Nothwehr, 1997;Kauppinen et al, 1999;Meszaros, Orosz, Mgyar, Mesko, & Vincze, 2003;Tousman, Zeitz, Taylor, & Bristol, 2007), the results of this study indicate that differences in asthma knowledge scores at follow-up likely reflect an effect of the educational programVthe goal of which was to enable patients to monitor, to control, and to manage their disease with the aid of an asthma workbook used through the study period. Despite intervention, the comparison group also showed an increased knowledge about asthma.…”

“…Patients are also often uninformed about the effect of education on HRQOL (Gallefoss et al, 1999). In addition, Kauppinen, Sintonen, Vilkka, and Tukiainen (1999) described that patient education did not increase HRQOL in patients with asthma.…”

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

“…Additional long term studies are needed to confirm the findings of this cost analysis of nurseled outpatient management in patients with more severe asthma. Previous studies have evaluated the effect of educational intervention by asthma nurses on the costs of management of asthma both in children and adults [10,12,[22][23][24][25]. The economical consequences of these interventions were inconclusive.…”

“…The economical consequences of these interventions were inconclusive. Some of these studies reported a cost reduction [10,12,22,23], whilst others found that extra investments were needed to achieve a reduction in healthcare utilisation of the patients [24,25]. In these studies, however, the asthma nurse intervention was additional to the routine medical care.…”

“…Furthermore, maintenance treatment with inhaled corticosteroids has been shown to be cost effective [19][20][21]. The consequences of intervention by asthma nurses on healthcare costs are, however, inconclusive [10,12,[22][23][24][25]. This may be due to the fact that until now, care provided by an asthma nurse has always been additional to routine medical care.…”