Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial.
BACKGROUND
Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review.


OBJECTIVE
To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews.


METHODS
Cost-effectiveness analysis based on a 3-month randomised controlled trial.


METHODS
Four general practices in England.


METHODS
Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation.


RESULTS
A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. Onehundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P <0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P <0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = pounds sterling 64.49 [SD = 73.33] versus surgery = pounds sterling 59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = pounds sterling 725.84 versus surgery = pounds sterling 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = pounds sterling 7.19 [SD = 2.49] versus surgery = pounds sterling 11.11 [SD = 3.50]; mean difference = - pounds sterling 3.92 [95% confidence interval = - pounds sterling 4.84 to pounds sterling 3.01], P <0.001).


CONCLUSIONS
Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved.
Pinnock
Hilary
H
Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh. hpinnock@gpiag-asthma.org
McKenzie
Lynda
L
Price
David
D
Sheikh
Aziz
A
D001249:Asthma / Q000191:economics* / Q000628:therapy; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods; D004739:England; D005194:Family Practice / Q000191:economics* / Q000458:organization & administration; D017048:Health Care Costs; D006801:Humans; D019114:Remote Consultation / Q000191:economics*; D011795:Surveys and Questionnaires; D013689:Telephone / Q000191:economics*
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