From: Systematic meta-review of supported self-management for asthma: a healthcare perspective
Reference; Country; Allocation concealment | Study type; Participants, n; Intervention(s) | Comparison | Target group(s) | Health economic results | Formal health economic evaluation, cost-effectiveness (societal and health service perspective) | |||
---|---|---|---|---|---|---|---|---|
Quality of life/asthma control | Healthcare utilisation (hospitalisation) | Total healthcare costs | Unscheduled care | |||||
Baptist 2013 [49] US Concealment not adequate | RCT n = 70 Personalised 6-session self-regulation education. | Usual care. FU: 12 mo | Older adults with asthma (>65 y). Mean age 74 y. 14% male. | Proportion with ACQ <0.75 was greater in I group than C group [I: 13 (41.9%) vs. C: 5 (15.6%)]. | I group had fewer hospitalisations (I: 0 vs. C: 4; p = 0.04). | n/a | No difference in A&E visits (I: 1 vs. C: 2; p = 0.58). I group had fewer unscheduled visits (I: 6 vs. C:14; p = 0.048). | n/a |
Castro 2003 [69] US Concealment not adequate | RCT n = 96 Education, psychosocial support, PAAP and co-ordination of care. | Usual (private) primary care. FU: 12 mo | Inpatients, adults with asthma. Mean age 38 y. 15% male. | No between-group difference in mean AQLQ [I: 4.0 (SD 1.3) vs. C: 3.9 (SD 1.5); p = 0.55]. | I group had fewer re-admissions/patient [I: 0.4 (SD 0.9) vs. C: 0.9 (SD 1.5); p = 0.04]. | I group had lower costs/patient [I: $5726 (SD 5679) vs. C: $12,188 (SD 19,352); MD $6,462; p = 0.03]. | No between-group differences in number A&E visits/patient [I:1.9 (SD 4.3) vs. C: 1.4 (SD = 1.5); p = 0.52]. | n/a |
Clark 2007 [70] US Concealment not adequate | RCT n = 808 Self-regulation intervention; nurse telephone-delivered. | Usual care. FU: 12 mo | Adult women with asthma. Mean age 49 y. 100% female | No between-group difference in mean AQLQ [I: 2.1 (SD 0.9) vs. C: 2.1 (SD 0.9]. | No between-group difference in admissions/patient [I: 0.2 (SD 0.7) vs. C: 0.1 (SD 0.5)] | n/a | I group had greater reduction in unscheduled visits [mean change: I: −0.63 (SD 2.4) vs. C: −0.24 (SD 1.5)]. | n/a |
de Oliveira 1999 [71] Brazil Concealment not adequate | RCT n = 52 Outpatient education programme, including a written PAAP. | Usual care. FU: 6 mo | Adults; moderate to severe asthma. Mean age 38 y. 15% male. | No between-group differences in QoL score [I: 28 (SD 17) vs. C: 50 (SD 15); p = 0.0005]. | No between-group differences in admissions/patient [I: 0 vs. C: 0.5 (SD 0.8); p = 0.08]. | n/a | I group had fewer A&E visits/patient [I: 0.7 (SD 1.0) vs. C: 2 (SD 2)]. | n/a |
Gallefoss 2001 [72] Norway Concealment not adequate | RCT n = 78 Group-plus individual self-management education with a written PAAP. | Usual primary care. FU: 12 mo | Adults with asthma. Mean age 44 y. 21% male. | Better QoL (SGRQ) in I group at 12 mo [I: 20 (SD 15) vs. C: 36.5 (SD 18); MD 16.3, 95% CI 16.3–24.4] | n/a | No between-group differences in total costs (in NOK) [I: 10,500 (SD 20,500) vs. C: 16,000 (SD 35,400); p = 0.510]. | n/a | Incremental SGRQ gain 16.3; health costs difference NOK1900; all cost diff NOK −5500. |
Gruffydd-Jones 2005 [73] UK Concealment not adequate | RCT n = 174 Targeted nurse-led telephone reviews, including PAAPs. | Usual primary care. FU: 12 mo | Adults with asthma. Mean age 50 y. 40% male. | No between-group difference in mean change in ACQ [I: −0.11 (95% CI −032 to 0.11) vs. C: −0.18 (95% CI −0.38 to 0.02); p = 0.349]. | n/a | No between-group difference in total costs [I: £209.85 (SD 220.94) vs. C: £333.85 (SD 410.64); MD £122.35; p = 0.071]. | n/a | n/a |
Honkoop 2015 [74] Netherlands Adequate concealment | RCT n = 611 Nurse-led care to symptom control (I) (or FeNO controlled). | Usual care (partially controlled). FU: 12 mo | Adults with asthma. Mean age 40 y. 28% male. | No between-group difference in EQ5D (QALYs) (I: 0.91 vs. C: 0.89; MD 0.01, 95% CI −0.02 to 0.04). | n/a | No between-group difference in total costs [I: $4591 vs. C: $4180; MD $411, 95% CI −904 to 1797; p > 0.05]. | n/a | n/a |
Kauppinen 1998 [75] Finland Concealment not adequate | RCT n = 162 Intensive education (use of inhaled drugs, PEF, monitoring and PAAP). | Conventional education. FU: 12 mo | Adults, newly diagnosed asthma. Mean age 43 y. 44% male. | No between-group difference in 15D [I: 0.93 (95% CI 0.90–0.94) vs. C: 0.91 (95% CI 0.89 to 0.94); p = 0.47]. | n/a | I group had greater total costs than control [I: £345 (95% CI 247–1758) vs. C: £294 (95% CI 0–8078); p < 0.001]. | n/a | Intensive education: incremental gain of 0.02 15D. Incremental difference in health costs of £51. |
Krieger 2015 [76] US Adequate concealment | RCT n = 366 Community health worker-supported self-management. | Usual care. FU: 12 mo | Adults with asthma. Mean age 41 y. 27% male. | Intervention improved QoL. Mean change in mAQLQ (I: 0.95 vs. C: 0.36; MD 0.50, 95% CI 0.28–0.71; p <0.001). | No difference in mean change in number of urgent care episodes. (I: −1.50 vs. C: −1.60; difference 0.09, 95% CI −0.59 to 0.73; p = 0.78.) | n/a | n/a | n/a |
Lahdensuo 1996 [77] Finland Concealment not adequate | RCT n = 122 Self-management, including breathing exercises, education and PEF monitoring. | Traditional treatment. FU: 12 m | Adults with asthma. Mean age 43 y. 48% male. | Intervention improved QoL SGRQ (symptom domain) [I: 16.6 (SD 15.9) vs. C: 8.4 (SD 18.4); p = 0.009]. | n/a | n/a | I group had fewer unscheduled care visits/patient/year (I: 0.5 vs. C:1; p = 0.04). | n/a |
Levy 2000 [78] UK Concealment not adequate | RCT n = 211 Structured education with PAAP by A&E specialist nurses. | Usual primary care. FU: 6 mo | Adults with asthma. Mean age 40 yrs. 43% male. | No between-group difference in SGRQ (I: 30.25 vs. C: 28.73; MD 1.52, 95% CI −4.05 to 7.09). | No between-group difference in hospital consultations [median (IQR) I: 0 (1–3) vs. C: 0 (1–6); p = 0.17]. | n/a | No between-group difference in GP consultations [median (IQR) I: 0 (1–7) vs. C: 0 (1–7); p = 0.14]. | n/a |
Mancuso 2011 [79] US Concealment not adequate | RCT n = 296 Self-management workbook, behavioural contract, telephone calls. | Information/PEF training. FU: 12 mo | Adults attending A&E with asthma. Mean age 43 y. 23% male. | No between-group difference in change in AQLQ at 1 y (I: 0.04 vs. C: 0.18; MD 0.22, 95% CI −0.15 to 0.60). | n/a | n/a | No between-group difference in proportion with A&E visits (I: 13% vs. C: 11%). | n/a |
McLean 2003 [80] Canada Adequate concealment | RCT n = 225 Pharmacist-led self-management, with PAAP. | Usual pharmacist care. FU: 7 mo | Adults with asthma. Mean age 38 y. 47% male. | Intervention improved QoL as mean AQLQ (I: 5.13 vs. C: 4.40; p = 0.0001). | No between-group difference in hospitalisations (I: 0.078 vs. C: 0.16; p = 0.94). | Intervention reduced total costs (costs per patient I: $150 vs. C: $351). | No between-group difference in A&E visits (I: 0.04 vs. C: 0.21; p = 0.48). | n/a |
Moudgil 2000 [81] UK Concealment not adequate | RCT n = 689 Individual education and optimisation of drug therapy. | Usual primary care. FU: 12 mo | Adults with asthma. Mean age 35 y. 47% male. | Greater improvement in QoL in I group (MD in change in AQLQ 0.22 , 95% CI 0.15–0.29). | No between-group difference in hospitalisations (OR 0.51, 95% CI 0.22–1.14). | n/a | No between-group difference in A&E visits (OR 0.63, 95% CI 0.23–1.68). | n/a |
Pilotto 2004 [82] Australia Concealment not adequate | Cluster RCT n = 170 Nurse-run asthma clinics including provision of PAAPs. | Usual primary care. FU: 9 mo | Adults with asthma. Mean age 50 y. 48% male. | No between-group difference in SGRQ (I: 27.3 vs. C: 27.0; MD −0.5 (−4.0 to 2.9). | No between-group difference in number admitted (I: 2 vs. C: 0; p = 0.499). | n/a | No between-group difference in number attending A&E (I: 2 vs. C: 0; p = 0.499). | n/a |
Pinnock 2003 [83] UK Adequate concealment | RCT n = 278 Nurse-delivered, routine telephone review. | Usual primary care. FU: 3 mo | Adults with asthma. Mean age 57 y. 41% male. | No between-group difference in mAQLQ (I: 5.17 vs. C: 5.17; MD 0.22, 95% CI −0.15 to 0.60). | No patients in either group had a hospital admission for asthma. | n/a | No patients in either group had an A&E attendance for asthma | n/a |
Price 2004 [84] UK Adequate concealment | Cluster RCT n = 1553 Use of PAAPs with adjustable maintenance dosing. | Usual care. FU: 3 mo | Adults with asthma. Mean age 48 y. 41% male. | No between-group difference in proportion with improved QoL (I: 22.5% vs. C: 23.6%). | No between-group difference in hospital admissions (I: 2 vs. C: 2). | Intervention reduced total costs (cost/day/patient I: £1.13 vs. C: £1.31; MD − £0.17, 95% CI -£0.11 to -£0.23). | No between-group difference in A&E visits (I: 5 vs. C: 11). | n/a |
Ryan 2012 [85] UK Adequate concealment | RCT n = 288 Mobile phone supported self-management. | Paper-based PAAPs. FU: 6 mo | Adults with asthma. Mean age 52 y. 41% male. | No between-group difference in mean change in mAQLQ (difference −0.10, 95% CI −0.16 to 0.34). | No between-group difference in hospital admissions for asthma (I: 3 vs. C: 1). | n/a | No between-group difference in A&E attendances for asthma (I: 3 vs. C: 0). | n/a |
Schermer 2002 [86] Netherlands Concealment not adequate | RCT n = 193 Guided self-management with education and PEF monitoring. | Usual primary care. FU: 24 mo | Adults with asthma. Mean age 39 y. 42% male. | No between-group difference in total AQLQ (I: 39 vs. C: 29; MD 10, 95% CI −3 to 23). | No hospital admissions in either treatment group. | No between-group difference in total costs (I: €1084 vs. C: €1097; MD − €13). | No A&E visits in either treatment group. | Incremental QALY gain 0.015. Incremental total cost − €13. Incremental health cost €11. Incremental health ICER €33/QALY. |
Shelledy 2009 [87] US Concealment not adequate | RCT n = 166 Nurse- (N) vs. respiratory therapist-(RT) led education and management. | Usual primary care. FU: 6 mo | Adults: A&E or admitted with asthma. Mean age 44 y. 22% male. | RT I group had greater change in SGRQ [I(RT) −11.0 vs. I(N) −6.0 vs. C: −2.5, p < 0.05). | I group had fewer hospitalisations [I(RT): 0.04 vs. I(N): 0 vs. C: 0.20; p < 0.05). | I group had lower hospitalisation costs [I(RT): $202 vs. I(N): $0 vs. C: $1065; p < 0.05]. | No between-group difference in A&E visits [I(RT): 0.09 vs. I(N): 0.26 vs. C: 0.37)]. | n/a |
Sundberg 2005 [88] Sweden Concealment not adequate | RCT n = 97 Interactive computer-based education plus nurse support. | Usual care. FU: 12 mo | Young adults with asthma. Mean age 19 y. 55% male. | No between-group difference in Living with Asthma Questionnaire (I: 163.6 vs. C: 166.2, p > 0.05). | No between-group difference in hospital admissions (1 admission in each group). | n/a | No between-group difference in A&E visits (I: 17 vs. C: 16). | n/a |
van der Meer 2011 [89] Netherlands Concealment not adequate | RCT n = 200 Internet-based self-management programme, including electronic PAAP. | Usual outpatient care. FU: 12 mo | Adults with asthma. Mean age 37 y. 55% male. | No between-group difference in EQ5D (I: 0.93 vs. C: 0.89; difference 0.006, 95% CI −0.042 to 0.054). | No between-group difference in hospital admissions (mean cost: I: $571 vs. C: $589; MD −17; p = 0.95). | No between-group difference in total healthcare costs (I: $2555 vs. C: $2518; MD − $37; p = 0.94). | n/a | Incremental QALY gain 0.024. Incremental total cost $641. Incremental health cost $37. Incremental health ICER $1541/QALY. |
Yilmaz 2002 [90] Turkey Concealment not adequate | RCT n = 80 Outpatient clinic, special education programme. | Usual primary care. FU: 36 mo | Adults with asthma. Mean age 29 y. 37% male. | I group had greater improvements in AQLQ (I: 197.1 vs. C: 176.7; p = 0.009). | No between-group difference in hospitalisations (I: 0 vs. C: 4); p > 0.05. | n/a | I group had fewer A&E visits (I: 0 vs. C: 7; p = 0.01). | n/a |
Yoon 1993 [91] Australia Concealment not adequate | RCT n = 76 Brief, group-based, education with a PAAP. | Usual outpatient care. FU: 10 mo | Inpatient adults. Mean age not reported. 28% male. | No between-group difference in QoL [I: 4.0 (SD 4.38) vs. C: 3.96 (SD = 3.34); p > 0.05). | I group had fewer participants with hospital admissions (I: 1 vs. C: 7; p < 0.001). | n/a | No between-group difference in A&E visits (I: 3 vs. C: 7). | n/a |