title: Is bronchial thermoplasty cost-effective as treatment for problematic asthma patients? Singapore's perspective on a global model.
abstract: Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a general framework for determining BT's cost-effectiveness in other healthcare settings.
  
  
  
  We developed a Markov model to estimate the costs and quality-adjusted life years (QALYs) gained with BT-OAT versus OAT from the societal and health system perspectives. The model was populated using Singapore-specific costs and transition probabilities and utilities from the literature. Sensitivity analyses were conducted to identify the main factors determining cost-effectiveness of BT-OAT.
  
  
  
  BT-OAT is not cost-effective relative to OAT over a 5-year time horizon with an incremental cost-effectiveness ratio (ICER) of $US138 889 per QALY from the societal perspective and $US139 041 per QALY from the health system perspective. The cost-effectiveness of BT-OAT largely depends on a combination of the cost of the BT procedure and the cost of asthma-related hospitalizations and emergency department (ED) visits.
  
  
  
  Based on established thresholds for cost-effectiveness, BT-OAT is not cost-effective compared with OAT in Singapore. Given its current clinical efficacy, BT-OAT is most likely to be cost-effective in a setting where the cost of BT procedure is low and costs of hospitalization and ED visits are high.
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Hai V
authors.identifier: 0000-0002-2578-170X
authors.initials: HV
authors.lastname: Nguyen
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Saideep
authors.initials: S
authors.lastname: Bose
authors.affiliation: Health Services and Systems Research, Duke NUS Medical School, Singapore.
authors.forename: Shweta
authors.initials: S
authors.lastname: Mital
authors.affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.|Office of Clinical, Academic and Faculty Affairs, Duke NUS Medical School, Singapore.
authors.forename: Anthony Chau Ang
authors.initials: ACA
authors.lastname: Yii
authors.affiliation: Division of Nursing, Singapore General Hospital, Singapore.
authors.forename: Shin Yuh
authors.initials: SY
authors.lastname: Ang
authors.affiliation: Health Services Research, Singhealth, Singapore.
authors.forename: Sean Shao Wei
authors.initials: SSW
authors.lastname: Lam
authors.affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.|Office of Clinical, Academic and Faculty Affairs, Duke NUS Medical School, Singapore.
authors.forename: Devanand
authors.initials: D
authors.lastname: Anantham
authors.affiliation: Health Services and Systems Research, Duke NUS Medical School, Singapore.
authors.forename: Eric
authors.initials: E
authors.lastname: Finkelstein
authors.affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.|Office of Clinical, Academic and Faculty Affairs, Duke NUS Medical School, Singapore.
authors.forename: Mariko Siyue
authors.initials: MS
authors.lastname: Koh
mesh_terms: D001249:Asthma / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D000074060:Bronchial Thermoplasty / Q000191:economics*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012846:Singapore; D016896:Treatment Outcome
keywords: bronchial thermoplasty; cost-effectiveness; markov modelling; optimized asthma therapy; problematic asthma