title: Cost-effectiveness of Internet-based self-management compared with usual care in asthma.
abstract: BACKGROUND
  Effectiveness of Internet-based self-management in patients with asthma has been shown, but its cost-effectiveness is unknown. We conducted a cost-effectiveness analysis of Internet-based asthma self-management compared with usual care.
  
  
  RESULTS
  Cost-effectiveness analysis alongside a randomized controlled trial, with 12 months follow-up. Patients were aged 18 to 50 year and had physician diagnosed asthma. The Internet-based self-management program involved weekly on-line monitoring of asthma control with self-treatment advice, remote Web communications, and Internet-based information. We determined quality adjusted life years (QALYs) as measured by the EuroQol-5D and costs for health care use and absenteeism. We performed a detailed cost price analysis for the primary intervention. QALYs did not statistically significantly differ between the Internet group and usual care: difference 0.024 (95% CI, -0.016 to 0.065). Costs of the Internet-based intervention were $254 (95% CI, $243 to $265) during the period of 1 year. From a societal perspective, the cost difference was $641 (95% CI, $-1957 to $3240). From a health care perspective, the cost difference was $37 (95% CI, $-874 to $950). At a willingness-to-pay of $50,000 per QALY, the probability that Internet-based self-management was cost-effective compared to usual care was 62% and 82% from a societal and health care perspective, respectively.
  
  
  CONCLUSIONS
  Internet-based self-management of asthma can be as effective as current asthma care and costs are similar.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN79864465.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. v.van_der_meer@lumc.nl
authors.forename: Victor
authors.initials: V
authors.lastname: van der Meer
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.forename: Moira J
authors.initials: MJ
authors.lastname: Bakker
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Sterk
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Job
authors.initials: J
authors.lastname: Kievit
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Sont
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D055815:Young Adult
references.citation: Respir Med. 2001 Jan;95(1):56-63
references.pmid: 11207019
references.citation: Pediatrics. 2007 Mar;119(3):569-78
references.pmid: 17332210
references.citation: Med Decis Making. 1998 Apr-Jun;18(2 Suppl):S68-80
references.pmid: 9566468
references.citation: Pharmacoeconomics. 2004;22(8):537-47
references.pmid: 15217309
references.citation: Stat Med. 1999 Mar 30;18(6):681-94
references.pmid: 10204197
references.citation: Health Econ. 2003 May;12(5):377-92
references.pmid: 12720255
references.citation: Int J Technol Assess Health Care. 2006 Fall;22(4):436-42
references.pmid: 16984676
references.citation: Eur Respir J. 1995 Jun;8(6):888-98
references.pmid: 7589374
references.citation: Am Rev Respir Dis. 1993 Apr;147(4):832-8
references.pmid: 8466117
references.citation: Int J Technol Assess Health Care. 1996 Spring;12(2):291-8
references.pmid: 8707502
references.citation: J Allergy Clin Immunol. 2005 Jun;115(6):1137-42
references.pmid: 15940125
references.citation: Telemed J E Health. 2007 Jun;13(3):257-68
references.pmid: 17603828
references.citation: Value Health. 2004 Sep-Oct;7(5):518-28
references.pmid: 15367247
references.citation: BMJ. 2009 Jan 12;338:a3006
references.pmid: 19139138
references.citation: Soc Sci Med. 1998 Apr;46(8):1087-93
references.pmid: 9579760
references.citation: BMJ. 2000 Dec 16;321(7275):1507-10
references.pmid: 11118179
references.citation: Eur Respir J. 1999 Oct;14(4):902-7
references.pmid: 10573240
references.citation: Qual Life Res. 2008 Apr;17(3):453-62
references.pmid: 18274882
references.citation: Chest. 1997 Dec;112(6):1534-8
references.pmid: 9404750
references.citation: Cost Eff Resour Alloc. 2007 Jul 27;5:10
references.pmid: 17662113
references.citation: Cochrane Database Syst Rev. 2003;(1):CD001117
references.pmid: 12535399
references.citation: Eur Respir J. 2001 Feb;17(2):206-13
references.pmid: 11334121
references.citation: Am J Respir Crit Care Med. 2002 Oct 15;166(8):1062-72
references.pmid: 12379549
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: Ann Intern Med. 2009 Jul 21;151(2):110-20
references.pmid: 19620163
references.citation: Eur Respir J. 2008 Sep;32(3):545-54
references.pmid: 18757695
references.citation: BMJ. 2004 Jul 24;329(7459):224-7
references.pmid: 15271836
references.citation: Med Care. 1997 Nov;35(11):1095-108
references.pmid: 9366889
references.citation: BMJ. 1998 Apr 11;316(7138):1138-9
references.pmid: 9552954