title: Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial.
abstract: 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.
authors.affiliation: Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh. hpinnock@gpiag-asthma.org
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Lynda
authors.initials: L
authors.lastname: McKenzie
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: 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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