American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 1062-1072, (2002)
© 2002 American Thoracic Society
Randomized Controlled Economic Evaluation of Asthma Self-Management in Primary Health Care
Tjard R. Schermer,
Bart P. Thoonen,
Guido van den Boom,
Reinier P. Akkermans,
Richard P. Grol,
Hans T. Folgering,
Chris van Weel and
Constant P. van Schayck
Department of General Practice/Family Medicine, Center for Quality of Care Research, and University Lungcentre Dekkerswald, University Medical Center St. Radboud, Nijmegen; and University of Maastricht, Maastricht, The Netherlands
Correspondence and requests for reprints should be addressed to Tjard R. Schermer, M.Sc., University Medical Center St. Radboud, Department of General Practice/Family Medicine, 229-HSV, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: T.Schermer{at}hsv.kun.nl
ABSTRACT
In this randomized controlled economic evaluation we compared guided asthma self-management with usual asthma care according to guidelines for Dutch family physicians. Nineteen family practices were randomized, and 193 adults with stable asthma (98 self-management, 95 usual care) were included and monitored for 2 years. We hypothesized that introducing self-management would not compromise asthma control and cost would be equal to or lower than in usual care. Patient-specific cost data were collected, preference-based utilities were assessed, and incremental cost per quality-adjusted life year (QALY) and successfully treated week gained was calculated. Self-management patients gained 0.039 QALY (95% confidence interval [CI], 0.003 to 0.075) and experienced 81 (95% CI, 78 to 84) successfully treated weeks in 2 years' time; the corresponding figures for usual care were 0.024 (95% CI, -0.022 to 0.071) and 75 (95% CI, 72 to 78). Total costs were €1,084 (95% CI, 938 to 1,228) for self-management and €1,097 (95% CI, 933 to 1,260) for usual care. Self-management patients consumed 1,680 (95% CI, 1,538 to 1,822) puffs of budesonide, usual care patients 1,897 (95% CI, 1,679 to 2,115). Mean productivity cost due to limited activity days was €213 lower among self-management patients. When all costs were included, self-management was cost-effective on all outcomes. The probability that self-management was cost-effective relative to usual care in terms of QALYs was 52%. We conclude that guided self-management is a safe and efficient alternative approach compared with asthma treatment usually provided in Dutch primary care.
Key Words: asthma • economics, pharmaceutical • family practice • patient education • randomized controlled trial
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