Cost-effectiveness of Internet-based self-management compared with usual care in asthma

Abstract

Background: Effectiveness of Internet-based self-management in patients with asthma has been shown, but its cost-effectiveness is unknown. We conducted a cost-effectiveness analysis of Internet-based asthma self-management compared with usual care.

Methodology and principal findings: Cost-effectiveness analysis alongside a randomized controlled trial, with 12 months follow-up. Patients were aged 18 to 50 year and had physician diagnosed asthma. The Internet-based self-management program involved weekly on-line monitoring of asthma control with self-treatment advice, remote Web communications, and Internet-based information. We determined quality adjusted life years (QALYs) as measured by the EuroQol-5D and costs for health care use and absenteeism. We performed a detailed cost price analysis for the primary intervention. QALYs did not statistically significantly differ between the Internet group and usual care: difference 0.024 (95% CI, -0.016 to 0.065). Costs of the Internet-based intervention were $254 (95% CI, $243 to $265) during the period of 1 year. From a societal perspective, the cost difference was $641 (95% CI, $-1957 to $3240). From a health care perspective, the cost difference was $37 (95% CI, $-874 to $950). At a willingness-to-pay of $50,000 per QALY, the probability that Internet-based self-management was cost-effective compared to usual care was 62% and 82% from a societal and health care perspective, respectively.

Conclusions: Internet-based self-management of asthma can be as effective as current asthma care and costs are similar.

Trial registration: Current Controlled Trials ISRCTN79864465.

Figure 1. Cost-effectiveness planes.

Uncertainty about cost-effectiveness of the asthma internet-based self-management program compared with usual asthma care (showing the 1000 bootstrapped estimates). Circles and triangles represent the incremental societal and health care costs, respectively, plotted against the incremental quality adjusted life years (QALY) (intervention minus usual care). The south-east quadrant indicates that internet-based self-management intervention dominates usual care (i.e. effectiveness is higher and costs are lower), the north-west quadrant indicates that usual care dominates the intervention. The points below the dashed diagonal lines are cost-effective at a willingness to pay threshold of $50000 and $100000 per QALY, respectively.

Figure 2. Cost-effectiveness acceptability curves.

The probability that Internet-based self-management is cost-effective compared to usual care depending on the willingness-to-pay per QALY from a societal perspective (solid line) and health care perspective (dashed line).