Randomized Controlled Economic Evaluation of Asthma Self-Management in Primary Health Care

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Abstract
In this randomized controlled economic evaluation we compared A systematic review including 23 trials concluded that self- guided asthma self-management with usual asthma care according management programs are able to improve health outcomes to guidelines for Dutch family physicians. Nineteen family practices in adult asthma if they include self-monitoring and are accom- were randomized, and 193 adults with stable asthma (98 self-man- panied with written action plans and regular medical profes- agement, 95 usual care) were included and monitored for 2 years. sional review (8). However, the trials included in this meta- We hypothesized that introducing self-management would not com- analysis have been conducted mainly in selected (secondary promise asthma control and cost would be equal to or lower than care) patients. in usual care. Patient-specific cost data were collected, preference- When competing for scarce health care resources it is not based utilities were assessed, and incremental cost per quality-ad- justed life year (QALY) and successfully treated week gained was sufficient to determine the effects of asthma self-management calculated. Self-management patients gained 0.039 QALY (95% con- programs solely in terms of health outcomes. It is also impor- fidence interval (CI), 0.003 to 0.075) and experienced 81 (95% CI, 78 tant to analyze whether the costs of introducing self-manage- to 84) successfully treated weeks in 2 years' time; the corresponding ment outweigh the—potential—subsequent savings in health figures for usual care were 0.024 (95% CI, 0.022 to 0.071) and 75 care utilization and productivity ("indirect") costs, the latter (95% CI, 72 to 78). Total costs were C 1,084 (95% CI, 938 to 1,228) resulting from fewer days of limited activities and incapacity for self-management and C 1,097 (95% CI, 933 to 1,260) for usual for work (9). If the savings do not outweigh the investments, care. Self-management patients consumed 1,680 (95% CI, 1,538 to it is essential to assess whether the additional—or incremen- 1,822) puffs of budesonide, usual care patients 1,897 (95% CI, 1,679 to 2,115). Mean productivity cost due to limited activity days was tal—costs of a self-management program can be justified by C 213 lower among self-management patients. When all costs were the health gains. included, self-management was cost-effective on all outcomes. The Meanwhile, several asthma guidelines recommend self- probability that self-management was cost-effective relative to usual management (10, 11) and health professionals and patients care in terms of QALYs was 52%. We conclude that guided self- with asthma themselves seem to appreciate the contemporary management is a safe and efficient alternative approach compared approach (12-14). A number of economic evaluations of