Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study - 02/10/14
Abstract |
Background |
Adherence to evidence-based controller treatments for asthma is disappointingly low in many jurisdictions. Quantifying the burden associated with suboptimal adherence in patients with uncontrolled asthma will help establish the priorities for policymakers.
Objective |
We sought to quantify the benefits in the United States of improving adherence to controller therapies in adults with uncontrolled asthma in terms of health care costs and quality-adjusted life years (QALYs).
Methods |
A Markov model of asthma was created to simulate the effect of treatment with controller medications on asthma control and exacerbations over a 10-year time horizon. Health care costs and QALYs associated with the current level of adherence (status quo) were compared with a hypothetical scenario in which each patient with uncontrolled asthma at baseline will be fully adherent to an evidence-based controller therapy (the full-adherence scenario). We also evaluated the cost-effectiveness of adherence interventions as a function of their costs and improvement in the adherence.
Results |
The status quo level of asthma management was associated with $2,786 costs and 7.55 QALYs over 10 years, whereas the corresponding values for the full-adherence scenario were $5,973 and 7.68, respectively. Consequently, the incremental cost-effectiveness ratio of the full-adherence versus the status quo was $24,515/QALY. To be cost-effective, a program that improves adherence by 50% should cost less than $130 ($450) per person annually at a willingness-to-pay value of $50,000/QALY ($100,000/QALY). Inclusion of productivity loss in the analysis resulted in the full-adherence scenario being cost-saving.
Conclusion |
Considering the extent of suboptimal adherence, our study shows that attempts in improving adherence to evidence-based therapies in patients with uncontrolled asthma can be associated with significant return on investment.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, cost-effectiveness analysis, decision analysis, evidence-based treatment, adherence
Abbreviations used : CEAC, GOAL, ICER, ICS, PDC, QALY, RCT, RR, WTP
Plan
| Supported in part through the Canadian Respiratory Research Network (CRRN: Institute of Cardiovascular and Respiratory Health Emerging Network Grants-#201306). Z.Z. received a 4-year fellowship award for his PhD studies from the University of British Columbia. M.S. receives salary support from the National Sanitarium Association. |
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| Disclosure of potential conflict of interest: L.D. Lynd has received research support from the Allergen National Centre of Excellence. J. M. FitzGerald has received research support and travel support from Allergen; is a board member for GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Boehringer Ingelheim, Altana, Merck, and Topigen; has received research support from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Merck, Wyeth, Schering, Genentech, and Topigen; and has received lecture fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Pfizer, and Merck. M. Sadatsafavi has received research support from the Allergen National Centre of Excellence. Z. Zafari declares no relevant conflicts of interest. |
Vol 134 - N° 4
P. 908 - octobre 2014 Retour au numéro
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