Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T19:40:25.647Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-utility of a disease management program for patients with asthma

Published online by Cambridge University Press:  01 April 2007

Lotte Steuten ,
Stephen Palmer ,
Bert Vrijhoef ,
Frits van Merode ,
Cor Spreeuwenberg  and
Hans Severens
Lotte Steuten
Affiliation:
Maastricht University
Stephen Palmer
Affiliation:
University of York
Bert Vrijhoef
Affiliation:
Maastricht University and University Hospital Maastricht
Frits van Merode
Affiliation:
Maastricht University
Cor Spreeuwenberg
Affiliation:
Maastricht University and Institute for Rehabilitation Research
Hans Severens
Affiliation:
Maastricht University and University Hospital Maastricht
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care.

Methods: A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets. A clinical trial was performed over a period of 15 months to collect data on costs and effects of the program and usual care. These data were used to inform a probabilistic decision-analytic model to estimate the 5-year impact of the program beyond follow-up. A societal perspective was adopted, with outcomes assessed in terms of costs per quality-adjusted life-year (QALY).

Results: The DMP is associated with a gain in QALYs compared to usual care (2.7±.2 versus 3.4±.8), at lower costs (€3,302±314 versus €2,973±304), thus leading to dominance. The probability that disease management is the more cost-effective strategy is 76 percent at a societal willingness to pay (WTP) for an additional QALY of €0, reaching 95 percent probability at a WTP of €1,000 per additional QALY.

Conclusions: Organizing health care according to the principles of disease management for adults with asthma has a high probability of being cost-effective and is associated with a gain in QALYs at lower costs.

Keywords

Disease managementEconomic evaluationDecision analysisAsthma
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 184 - 191
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Barnes, PJ, Johnsson, B, Klim, JB. The costs of asthma. Eur Respir J. 1996; 9: 636–642.CrossRefGoogle ScholarPubMed
2.Bodenheimer, T, Wagner, EH, Grumbach, K. Improving care for patients with chronic illness: The chronic care model, part 2. JAMA. 2002; 288: 1909–1914.CrossRefGoogle ScholarPubMed
3.Briggs, AH, Sculpher, M. An introduction to Markov modeling for economic evaluation. Pharmacoeconomics. 1998; 13: 397–409.CrossRefGoogle ScholarPubMed
4.Briggs, A, Goeree, R, Blackhouse, G, O'Brien, B. Probabilistic analysis of cost-effectiveness models: Choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making. 2002; 22: 290–308.CrossRefGoogle ScholarPubMed
5.Briggs, AH, Ades, AE, Price, MJ. Probabilistic sensitivity analysis for decision trees with multiple branches: Use of the Dirichlet distribution in a Bayesian framework. Med Decis Making. 2003; 23: 341–350.CrossRefGoogle Scholar
6.Brouwer, WBF, Koopmanschap, MA, Rutten, FFH. Productivity costs in cost-effectiveness analysis: Numerator or denominator: A further discussion. Health Econ. 1997; 6: 511–514.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
7.Central Office of Statistics. Available at: www.cbs.nl/nl/publicaties/publicaties/algemeen/statistisch-jaarboek/a-26-2004. pdf [in Dutch]. Accessed 24 October 2006.Google Scholar
8.Claxton, K, Sculpher, M, Drummond, M. A rational framework for decision-making by the National Institute For Clinical Excellence (NICE). Lancet. 2002; 360: 711–715.CrossRefGoogle ScholarPubMed
9.Drummond, MF, O'Brien, B, Stoddart, G, Torrance, G. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1997.Google Scholar
10.Drummond, MF, McGuire, A. Economic evaluation in health care: Merging theory with practice. Oxford: Oxford University Press; 2001.CrossRefGoogle Scholar
11.Ellrodt, G, Cook, DJ, Lee, J et al. , Evidence based disease management. JAMA. 1997; 278: 1687–1692.CrossRefGoogle ScholarPubMed
12.Fetterolf, D, Sidorov, J. Disease management program evaluation guide. Washington: Disease Management Association of America; 2004.Google Scholar
13.Gelman, A, Carlin, JB, Stern, HS. Bayesian data analysis. London: Chapman & Hall; 1995.CrossRefGoogle Scholar
14.Hunink, MGM, Glasziou, PP, Siegel, JE. Decision making in health and medicine: Integrating evidence and values. Cambridge, England: Cambridge University Press; 2001.Google Scholar
15.Johannesson, M. Avoiding double counting in pharmacoeconomic studies. Pharmacoeconomics. 1997; 11: 385–388.CrossRefGoogle ScholarPubMed
16.Linden, A, Adams, JL, Roberts, N. Evaluating disease management program effectiveness: An introduction to time-series analysis. Dis Manag. 2003; 6: 243–255.CrossRefGoogle ScholarPubMed
17.Linden, A, Adams, JL, Roberts, N. Using an empirical method for establishing clinical outcome targets in disease management programs. Dis Manag. 2004; 7: 93–101.CrossRefGoogle ScholarPubMed
18.Masoli, M, Fabian, D, Holt, S, Beasley, R, for, the Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA Dissemination Committee Report. Allergy. 2004; 59: 469–478.CrossRefGoogle ScholarPubMed
19.National Institutes of Health. Global Initiative for Asthma. Pocket guide for asthma management and prevention. Publication No. 95-3659B. Baltimore, MD: National Institutes of Health, National Heart, Lung and Blood Institute; 1998.Google Scholar
20.Oostenbrink, JB, Koopmanschap, MA, Rutten, FFH. Guidelines for economic evaluations: Methods and standard cost prices for economic evaluations in health care. [Handleiding voor kostenonderzoek: methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2004]. Amstelveen: Health Insurance Council; 2004.Google Scholar
21.Pharmacotherapeutic Compass. Available at: http://www.fk.cvz.nl/[in Dutch]. Accessed 24 October 2006.Google Scholar
22.Price, MJ, Briggs, AH. Development of an economic model to assess the cost-effectiveness of asthma management strategies. Pharmacoeconomics. 2002; 20: 183–194.CrossRefGoogle ScholarPubMed
23.Ross, TK. Analysing health care operations using ABC. J Health Care Finance. 2004; 30: 1–20.Google Scholar
24.Schermer, TR, Thoonen, BP, Van, den Boom G et al. , Randomized controlled economic evaluation of asthma self-management in primary health care. Am J Resp Crit Care Med. 2002; 166: 1062–1072.CrossRefGoogle ScholarPubMed
25.Steuten, L, Vrijhoef, B, Van, Merode G, Wesseling, GJ, Spreeuwenberg, C. Evaluation of a regional disease management programme for patients with asthma or chronic obstructive pulmonary disease. Int J Qual Health Care. 2006; 18: 429–436.CrossRefGoogle ScholarPubMed
26.Steuten, LMG, Vrijhoef, HJM, Van, Merode GG, Severens, JL, Spreeuwenberg, C. The health technology assessment—Disease management instrument reliably measured methodologic quality of health technology assessment of disease management. J Clin Epidemiol. 2004; 57: 881–888.CrossRefGoogle ScholarPubMed
27.Stinnett, AA, Mullahay, J. Net health benefits: A new framework for the analysis of uncertainty in cost in cost-effectiveness analysis. Med Decis Making. 1998; 18: S65–S80.CrossRefGoogle Scholar
28.Szende, Á, Svensson, K, Stähl, E, Mészáros, Á, Berta, GA. Psychometric and utility-based measures of health status of asthmatic patients with different disease control level. Pharmacoeconomics. 2004; 22: 537–547.CrossRefGoogle ScholarPubMed
29.The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16: 199–208.CrossRefGoogle Scholar
30.Van, Hout BA, AL, MJ, Gordon, GS et al. , Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994; 3: 309–319.Google Scholar
31.Vrijhoef, HJM, Spreeuwenberg, C, Eijkelberg, IMJG, Wolffenbuttel, BHR, Van, Merode G. Adoption of disease management model for diabetes in the region of Maastricht. BMJ. 2001; 323: 983–985.CrossRefGoogle ScholarPubMed
32.Weinstein, MC, Siegel, JE, Garber, AM et al. , Productivity costs, time costs and health-related quality of life: A response to the Erasmus group. Health Econ. 1997; 6: 505–510.3.0.CO;2-I>CrossRefGoogle Scholar
Supplementary material: PDF

Steuten_et_al supplementary

Steuten_et_al supplementary

Download Steuten_et_al supplementary(PDF)
PDF 52.5 KB