title: Cost Effectiveness of Outpatient Asthma Clinics.
abstract: BACKGROUND
  Asthma clinics (AC) are hospital outpatient services specialising in the management of asthma. In this study, we analysed the impact of these clinics on asthma management and their cost effectiveness in comparison with standard outpatient services.
  
  
  METHODS
  A case cross-over study in which all new patients seen in the AC of Lugo in 2012 were included. The case period was defined as one year following the first visit to the AC; the control period was defined as the preceding year. We calculated changes in clinical quality indicators for asthma management, and estimated the incremental cost-effectiveness ratio (ICER) for each additional patient treated and for each quality-adjusted life year (QALY) RESULTS: The number of patients (n=83, mean age 49 ± 15.2 years; 60.2% women) managed in the AC increased from 41% to 86%. The Asthma Control Test score increased from 18.7 ± 4.6 to 22.6 ± 2.3 (p<0.05) and FEV1 increased from 81.4% ± 17.5 to 84.4% ± 16.6 (p<0.05). The number of exacerbations, hospitalisations and visits to accident and emergency fell by 75%. The number of patients given combination LABA+ICS therapy fell from 79.5% to 41%. The use of other drug therapy increased: anticholinergics, from 3.6% to 16.9%; ICS in monotherapy, from 3.6% to 45.8%; and omalizumab, from 0% to 6%. ICERs per patient managed and per QALY gained were €1,399 and €6,876, respectively (social perspective).
  
  
  CONCLUSIONS
  Treatment in ACs is cost-effective and beneficial in asthma management.
authors.affiliation: Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España. Electronic address: eremos26@hotmail.com.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Pérez de Llano
authors.affiliation: Instituto Max Weber, Madrid, España.
authors.forename: Renata
authors.initials: R
authors.lastname: Villoro
authors.affiliation: Instituto Max Weber, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Merino
authors.affiliation: Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España.
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: Gómez Neira
authors.affiliation: Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España.
authors.forename: Camino
authors.initials: C
authors.lastname: Muñiz
authors.affiliation: Departamento de Economía, Universidad de Castilla la Mancha, Toledo, España.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Hidalgo
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D000554:Ambulatory Care Facilities; D001249:Asthma / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Asma; Asthma; Asthma clinic; Calidad de vida; Control; Cost-effectiveness; Coste-efectividad; Management; Quality of life; Unidad monográfica