title: Randomized controlled economic evaluation of asthma self-management in primary health care.
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 euros(95% CI, 938 to 1,228) for self-management and 1,097 euros (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 euros 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.
authors.affiliation: Department of General Practice/Family Medicine, Center for Quality of Care Research, and University Lungcentre Dekkerswald, University Medical Center St. Radboud, Nijmegen, The Netherlands.
authors.forename: Tjard R
authors.initials: TR
authors.lastname: Schermer
authors.forename: Bart P
authors.initials: BP
authors.lastname: Thoonen
authors.forename: Guido
authors.initials: G
authors.lastname: van den Boom
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: Richard P
authors.initials: RP
authors.lastname: Grol
authors.forename: Hans T
authors.initials: HT
authors.lastname: Folgering
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Constant P
authors.initials: CP
authors.lastname: van Schayck
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001249:Asthma / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019819:Budesonide / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D005194:Family Practice; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009426:Netherlands; D010353:Patient Education as Topic / Q000191:economics*; D010366:Peak Expiratory Flow Rate; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D019819:Budesonide