Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study
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...
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| Veröffentlicht in: | Journal of allergy and clinical immunology 2014-10, Vol.134 (4), p.908-915.e3 |
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| creator | Zafari, Zafar, BSc, MSc Lynd, Larry D., PhD FitzGerald, J. Mark, MD Sadatsafavi, Mohsen, MD, PhD |
| description | 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. |
| doi_str_mv | 10.1016/j.jaci.2014.04.009 |
| format | Article |
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Mark, MD ; Sadatsafavi, Mohsen, MD, PhD</creator><creatorcontrib>Zafari, Zafar, BSc, MSc ; Lynd, Larry D., PhD ; FitzGerald, J. Mark, MD ; Sadatsafavi, Mohsen, MD, PhD</creatorcontrib><description>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.</description><identifier>ISSN: 0091-6749</identifier><identifier>EISSN: 1097-6825</identifier><identifier>DOI: 10.1016/j.jaci.2014.04.009</identifier><identifier>PMID: 24875619</identifier><identifier>CODEN: JACIBY</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>adherence ; Adult ; Age ; Allergy and Immunology ; Anti-Asthmatic Agents - economics ; Anti-Asthmatic Agents - therapeutic use ; Asthma ; Asthma - drug therapy ; Asthma - economics ; Biological and medical sciences ; Chronic obstructive pulmonary disease, asthma ; Computer Simulation ; Cost of Illness ; Cost-Benefit Analysis ; cost-effectiveness analysis ; Costs ; decision analysis ; Evidence-Based Medicine ; evidence-based treatment ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Health Care Costs ; Humans ; Immunopathology ; Markov Chains ; Medical sciences ; Medication Adherence ; Patients ; Pneumology ; Population ; Quality-Adjusted Life Years ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Time Factors ; United States</subject><ispartof>Journal of allergy and clinical immunology, 2014-10, Vol.134 (4), p.908-915.e3</ispartof><rights>American Academy of Allergy, Asthma & Immunology</rights><rights>2014 American Academy of Allergy, Asthma & Immunology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c572t-ad84606b4e03ca74fbbcd4335dcf9e77fd849c6922808107805e3ff9a974dc503</citedby><cites>FETCH-LOGICAL-c572t-ad84606b4e03ca74fbbcd4335dcf9e77fd849c6922808107805e3ff9a974dc503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0091674914005703$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28887061$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24875619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zafari, Zafar, BSc, MSc</creatorcontrib><creatorcontrib>Lynd, Larry D., PhD</creatorcontrib><creatorcontrib>FitzGerald, J. Mark, MD</creatorcontrib><creatorcontrib>Sadatsafavi, Mohsen, MD, PhD</creatorcontrib><title>Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study</title><title>Journal of allergy and clinical immunology</title><addtitle>J Allergy Clin Immunol</addtitle><description>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.</description><subject>adherence</subject><subject>Adult</subject><subject>Age</subject><subject>Allergy and Immunology</subject><subject>Anti-Asthmatic Agents - economics</subject><subject>Anti-Asthmatic Agents - therapeutic use</subject><subject>Asthma</subject><subject>Asthma - drug therapy</subject><subject>Asthma - economics</subject><subject>Biological and medical sciences</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Computer Simulation</subject><subject>Cost of Illness</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effectiveness analysis</subject><subject>Costs</subject><subject>decision analysis</subject><subject>Evidence-Based Medicine</subject><subject>evidence-based treatment</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Immunopathology</subject><subject>Markov Chains</subject><subject>Medical sciences</subject><subject>Medication Adherence</subject><subject>Patients</subject><subject>Pneumology</subject><subject>Population</subject><subject>Quality-Adjusted Life Years</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Time Factors</subject><subject>United States</subject><issn>0091-6749</issn><issn>1097-6825</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkltrFDEUxwdRbF39Aj5IQARfdj2ZyeQiRSilXqDgg_ocsrmwWTOTNckoi1-mn6WfzAy7ttAHEQ6EnPzOLf_TNM8xrDBg-ma72irtVy1gsoJqIB40pxgEW1Le9g-b0-rBS8qIOGme5LyFeu-4eNyctISznmJx2vy-1HGMg9dIjQZtrAplg6xzVhcUHXJTCEiZjU121BaViCpeUgzBppvrUv1qt0d-rMwUSka_fA2fxlvIIJXLZlBv0fnNdfbDFFTxcUS5TGb_tHnkVMj22fFcNN_eX369-Li8-vzh08X51VL3rC1LZTihQNfEQqcVI2691oZ0XW-0E5YxV9-FpqJtOXAMjENvO-eEEowY3UO3aF4f8u5S_DHZXOTgs7YhqNHGKUtM25YC70X3HygIEJxiUtGX99BtnNJYB6kUJrh20uNKtQdKp5hzsk7ukh9U2ksMclZRbuWsopxVlFCtarRoXhxTT-vBmtuQv7JV4NURUFmr4JIatc93HOecAZ2rnx04W7_3p7dJZu1nJY1PVWFpov93H-_uhevgR18rfrd7m-_mlbmVIL_M-zavGyYAPYOu-wP3NNGQ</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Zafari, Zafar, BSc, MSc</creator><creator>Lynd, Larry D., PhD</creator><creator>FitzGerald, J. Mark, MD</creator><creator>Sadatsafavi, Mohsen, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7SS</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study</title><author>Zafari, Zafar, BSc, MSc ; Lynd, Larry D., PhD ; FitzGerald, J. Mark, MD ; Sadatsafavi, Mohsen, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c572t-ad84606b4e03ca74fbbcd4335dcf9e77fd849c6922808107805e3ff9a974dc503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>adherence</topic><topic>Adult</topic><topic>Age</topic><topic>Allergy and Immunology</topic><topic>Anti-Asthmatic Agents - economics</topic><topic>Anti-Asthmatic Agents - therapeutic use</topic><topic>Asthma</topic><topic>Asthma - drug therapy</topic><topic>Asthma - economics</topic><topic>Biological and medical sciences</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Computer Simulation</topic><topic>Cost of Illness</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effectiveness analysis</topic><topic>Costs</topic><topic>decision analysis</topic><topic>Evidence-Based Medicine</topic><topic>evidence-based treatment</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Immunopathology</topic><topic>Markov Chains</topic><topic>Medical sciences</topic><topic>Medication Adherence</topic><topic>Patients</topic><topic>Pneumology</topic><topic>Population</topic><topic>Quality-Adjusted Life Years</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Time Factors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zafari, Zafar, BSc, MSc</creatorcontrib><creatorcontrib>Lynd, Larry D., PhD</creatorcontrib><creatorcontrib>FitzGerald, J. Mark, MD</creatorcontrib><creatorcontrib>Sadatsafavi, Mohsen, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of allergy and clinical immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zafari, Zafar, BSc, MSc</au><au>Lynd, Larry D., PhD</au><au>FitzGerald, J. Mark, MD</au><au>Sadatsafavi, Mohsen, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><addtitle>J Allergy Clin Immunol</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>134</volume><issue>4</issue><spage>908</spage><epage>915.e3</epage><pages>908-915.e3</pages><issn>0091-6749</issn><eissn>1097-6825</eissn><coden>JACIBY</coden><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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>24875619</pmid><doi>10.1016/j.jaci.2014.04.009</doi><tpages>8</tpages></addata></record> |
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| subjects | adherence Adult Age Allergy and Immunology Anti-Asthmatic Agents - economics Anti-Asthmatic Agents - therapeutic use Asthma Asthma - drug therapy Asthma - economics Biological and medical sciences Chronic obstructive pulmonary disease, asthma Computer Simulation Cost of Illness Cost-Benefit Analysis cost-effectiveness analysis Costs decision analysis Evidence-Based Medicine evidence-based treatment Fundamental and applied biological sciences. Psychology Fundamental immunology Health Care Costs Humans Immunopathology Markov Chains Medical sciences Medication Adherence Patients Pneumology Population Quality-Adjusted Life Years Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Time Factors United States |
| title | Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study |
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