Cost-effectiveness of Internet-based self-management compared with usual care in asthma

Victor van der Meer, Wilbert B van den Hout, Moira J Bakker, Klaus F Rabe, Peter J Sterk, Willem J J Assendelft, Job Kievit, Jacob K Sont, SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group, W J J Assendelft, H A Thiadens, M J Bakker, W B van den Hout, J Kievit, V van der Meer, J K Sont, A A Kaptein, E R V M Rikkers-Mutsaerts, K F Rabe, E H Bel, P J Sterk, S B Detmar, W Otten, H F van Stel, A C Roldaan, J C de Jongste, P J Toussaint, Victor van der Meer, Wilbert B van den Hout, Moira J Bakker, Klaus F Rabe, Peter J Sterk, Willem J J Assendelft, Job Kievit, Jacob K Sont, SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group, W J J Assendelft, H A Thiadens, M J Bakker, W B van den Hout, J Kievit, V van der Meer, J K Sont, A A Kaptein, E R V M Rikkers-Mutsaerts, K F Rabe, E H Bel, P J Sterk, S B Detmar, W Otten, H F van Stel, A C Roldaan, J C de Jongste, P J Toussaint

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.

Methodology and principal findings: 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.

Trial registration: Current Controlled Trials ISRCTN79864465.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Cost-effectiveness planes.
Figure 1. Cost-effectiveness planes.
Uncertainty about cost-effectiveness of the asthma internet-based self-management program compared with usual asthma care (showing the 1000 bootstrapped estimates). Circles and triangles represent the incremental societal and health care costs, respectively, plotted against the incremental quality adjusted life years (QALY) (intervention minus usual care). The south-east quadrant indicates that internet-based self-management intervention dominates usual care (i.e. effectiveness is higher and costs are lower), the north-west quadrant indicates that usual care dominates the intervention. The points below the dashed diagonal lines are cost-effective at a willingness to pay threshold of $50000 and $100000 per QALY, respectively.
Figure 2. Cost-effectiveness acceptability curves.
Figure 2. Cost-effectiveness acceptability curves.
The probability that Internet-based self-management is cost-effective compared to usual care depending on the willingness-to-pay per QALY from a societal perspective (solid line) and health care perspective (dashed line).

References

    1. National Institutes of Health. Global initiative for asthma. Global strategy for asthma management and prevention. 1995. NIH Publication No 02-3659, updated 2006.
    1. National Heart Lung and Blood Institute. National Asthma Education and Prevention Program (NAEPP) 2007. Expert panel report 3: guidelines for the Diagnosis and Management of Asthma.
    1. Taylor DR, Bateman ED, Boulet L-P, Boushey HA, Busse WW, et al. A new perspective on concepts of asthma severity and control. Eur Respir J. 2008;32:545–554.
    1. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, et al. The Cochrane Library, Issue 1. Oxford: Update Software; 2003. Self-management education and regular practitioner review for adults with asthma (Cochrane review).
    1. Willems DC, Joore MA, Hendriks JJ, Wouters EF, Severens JL. Cost-effectiveness of self-management in asthma: a systematic review of peak flow monitoring interventions. Int J Technol Assess Health Care. 2006;22:436–442.
    1. Cowie RL, Revitt SG, Underwood MF, Field SK. The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. Chest. 1997;112:1534–1538.
    1. Ghosh CS, Ravindran P, Joshi M, Stearns SC. Reductions in hospital use from self-management training for chronic asthmatics. Soc Sci Med. 1998;46:1087–1093.
    1. Lahdensuo A, Haahtela T, Herrala J, Kava T, Kiviranta K, et al. Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland. BMJ. 1998;316:1138–1139.
    1. Gallefoss F, Bakke PS. Cost-effectiveness of self-management in asthmatics: A 1-yr follow-up randomised, controlled trial. Eur Respir J. 2001;17:206–213.
    1. Schermer TR, Thoonen BP, Van den Boom G, Akkermans RP, Grol RP, et al. Randomized controlled economic evaluation of asthma self-management in primary health care. Am J Respir Crit Care Med. 2002;166:1062–1072.
    1. Willems DCM, Joore MA, Hendriks JJE, Wouters EFM, Severens JL. Cost-effectiveness of a nurse-led telemonitoring intervention base on peak expiratory flow measurements in asthmatics: results of a randomised controlled trial. Cost Eff Resour Alloc. 2007;5:10.
    1. Jones A, Pill R, Adams S. Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ. 2000;321:1507–1510.
    1. Van der Meer V, Bakker MJ, Van den Hout WB, Rabe KF, Sterk PJ, et al. Internet-Based Self-Management plus Education Compared to Usual Care in Asthma: a Randomized Controlled Trial. Ann Intern Med. 2009;151:110–120.
    1. Rasmussen LM, Phanareth K, Nolte H, Backer V. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol. 2005;115:1137–1142.
    1. Chan DS, Callahan CW, Hatch-Pigott VB, Lawless A, Proffitt L, et al. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Pediatrics. 2007;119:569–578.
    1. Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, et al. An Internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Telemed J E Health. 2007;13:257–268.
    1. Lamberts H, Wood M. International Classification of Primary Care. Oxford: Oxford University Press; 1987.
    1. Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14:902–907.
    1. The EuroQol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.
    1. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35:1095–1108.
    1. Rutten-van Mölken MPMH, Custers F, Van Doorslaer EKA, Jansen CCM, Heurman L, et al. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J. 1995;8:888–898.
    1. Stiggelbout AM, Eijkemans MJ, Kiebert GM, Kievit J, Leer JW, et al. The ‘utility’of the visual analog scale in medical decision making and technology assessment. Is it an alternative to the time trade-off? Int J Technol Assess Health Care. 1996;12:291–298.
    1. Briggs A, Clark T, Wolstenholme J, Clarke P. Missing… presumed at random: cost-analysis of incomplete data. Health Econ. 2003;12:377–392.
    1. Van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18:681–694.
    1. Oostenbrink JB, Koopmanschap MA, Rutten FFH. Manual for cost analyses, methods and standard prices for economic evaluations in health care. [In Dutch.] Amstelveen: Dutch Health Insurance Executive Board; 2004.
    1. Dutch Health Insurance Executive Board. Pharmacotherapeutic Compass [in Dutch]. 2007. Available: . Accessed 2007 November.
    1. Statistics Netherlands. Consumer price index. 2008. Available: . Accessed 2008 July 2.
    1. OECD. Purchasing Power Parities (PPPs) for OECD Countries 1980–2006. 2008 Available: . Accessed 2008 July 2.
    1. Rubin DB. Multiple imputation for non response in surveys. New York: J Wiley; 1987.
    1. Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998;18:S68–S80.
    1. Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004;7:518–528.
    1. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004;329:224–227.
    1. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis. 1993;147:832–838.
    1. McTaggart-Cowan HM, Marra CA, Yang Y, Brzazier JE, Kopec JA, et al. The validity of generic and condition-specific preference-based instruments: the ability to discriminate asthma control status. Qual Life Res. 2008;17:453–462.
    1. Szende A, Svensson K, Ståhl E, Mészáros A, Berta GY. Psychometric and utility-based measures of health status of asthmatic patients with different disease control level. Pharmacoeconomics. 2004;22:537–547.
    1. Contopoulos-Ioannidis DG, Karvouni A, Kouri I, Ioannidis JPA. Reporting and interpretation of SF-36 outcomes in randomised trials: systematic review. BMJ. 2009;338:a3006.
    1. Kauppinen R, Vilkka V, Sintonen H, Klaukka T, Tukiainen H. Long-term economic evaluation of intensive patient education during the first treatment year in newly diagnosed adult asthma. Respir Med. 2001;95:56–63.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa