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J Asthma. 2004 Aug;41(5):559-65.

A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population.

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Division of Allergy and Immunology, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.



Asthma education and action plans (AP) have been recognized as important components in the optimal management of asthma. Studies have differed on the importance of a peak flow-based self-management plans in reducing health care costs and use due to asthma exacerbation.


To analyze the cost-effectiveness of peak flow-based action plans in reducing costs associated with ER visits and hospitalizations due to acute asthma exacerbation in a population of high-risk and high-cost patients, defined as patients with moderate to severe asthma with a history of recent urgent treatment in the ER or hospitalization due to asthma.


A literature review of randomized clinical trials comparing peak flow-based (PFB) action plans, symptom-based (SB) action plans, and usual care/no action plan (NAP) was performed. Probability values regarding the effectiveness of each alternative (as measured by increase/decrease in ER visits and hospitalizations over a 6-month period) were derived. Incremental cost-effectiveness and cost-benefit ratios were calculated for each alternative. Sensitivity analyses were performed.


For high-risk and high-cost asthma patients, our analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based self-management plan. The peak flow-based self-management program had an incremental cost-effectiveness (C/E) ratio of $ 60.57 per ER visit averted compared to usual care/NAP and a C/E ratio of $31.46 compared to the SB-AP. The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an incremental C/E ratio of $300 per hospitalization prevented, compared with usual care and a C/E ratio of $311, compared to a SB-AP. Analysis yielded a cost-benefit ratio of 13.79 for the PFB-AP compared to NAP; the SB-AP had a cost-benefit ratio of 11.53 compared to NAP.


Cost-effectiveness and cost-benefit analyses reveal that for high-cost patients, a peak flow-based asthma education and self-management plan program is the most cost-effective alternative in reducing costs associated with ER visits and hospitalizations due to asthma exacerbation. Further refinements to this cost-effectiveness analysis including measuring changes in drug use and costs and patients' productivity losses need to be pursued and may demonstrate additional cost-savings due to peak flow-based asthma education plans.

[Indexed for MEDLINE]

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