Cost-utility of a disease management program for patients with asthma.
OBJECTIVE
The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care.


METHODS
A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets. A clinical trial was performed over a period of 15 months to collect data on costs and effects of the program and usual care. These data were used to inform a probabilistic decision-analytic model to estimate the 5-year impact of the program beyond follow-up. A societal perspective was adopted, with outcomes assessed in terms of costs per quality-adjusted life-year (QALY).


RESULTS
The DMP is associated with a gain in QALYs compared to usual care (2.7+/-.2 versus 3.4+/-.8), at lower costs (3,302+/-314 euro versus 2,973+/-304 euro), thus leading to dominance. The probability that disease management is the more cost-effective strategy is 76 percent at a societal willingness to pay (WTP) for an additional QALY of 0 euro, reaching 95 percent probability at a WTP of 1,000 euro per additional QALY.


CONCLUSIONS
Organizing health care according to the principles of disease management for adults with asthma has a high probability of being cost-effective and is associated with a gain in QALYs at lower costs.
Steuten
Lotte
L
Department of Health Care Studies, Maastricht University, The Netherlands. L.Steuten@zw.unimaas.nl
Palmer
Stephen
S
Vrijhoef
Bert
B
van Merode
Frits
F
Spreeuwenberg
Cor
C
Severens
Hans
H
D001249:Asthma / Q000628:therapy*; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D019468:Disease Management; D017048:Health Care Costs; D006801:Humans; D009426:Netherlands; D011795:Surveys and Questionnaires