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Clinical Trial
. 2005 Feb;55(511):119-24.

Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial

Hilary Pinnock  1 , Lynda McKenzie, David Price, Aziz Sheikh
Affiliations
Clinical Trial

Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial

Hilary Pinnock et al. Br J Gen Pract. 2005 Feb.

Abstract

Background: Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review.

Aim: To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews.

Design of study: Cost-effectiveness analysis based on a 3-month randomised controlled trial.

Setting: Four general practices in England.

Method: Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation.

Results: A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. Onehundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P <0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P <0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = pounds sterling 64.49 [SD = 73.33] versus surgery = pounds sterling 59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = pounds sterling 725.84 versus surgery = pounds sterling 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = pounds sterling 7.19 [SD = 2.49] versus surgery = pounds sterling 11.11 [SD = 3.50]; mean difference = - pounds sterling 3.92 [95% confidence interval = - pounds sterling 4.84 to pounds sterling 3.01], P <0.001).

Conclusions: Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved.

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Figures

Figure 1
Figure 1
Sensitivity analysis I: Cost saving per consultation achieved by telephone compared to proportion reviewed in the surgery.
Figure 2
Figure 2
Sensitivity analysis II: Cost saving per consultation achieved by duration of telephone consultation compared to duration of surgery review.
See this image and copyright information in PMC

References

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