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Is bronchial thermoplasty cost-effective as treatment for problematic asthma patients? Singapore's perspective on a global model.
- Source :
-
Respirology (Carlton, Vic.) [Respirology] 2017 Aug; Vol. 22 (6), pp. 1102-1109. Date of Electronic Publication: 2017 Mar 31. - Publication Year :
- 2017
-
Abstract
- Background and Objective: Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a general framework for determining BT's cost-effectiveness in other healthcare settings.<br />Methods: We developed a Markov model to estimate the costs and quality-adjusted life years (QALYs) gained with BT-OAT versus OAT from the societal and health system perspectives. The model was populated using Singapore-specific costs and transition probabilities and utilities from the literature. Sensitivity analyses were conducted to identify the main factors determining cost-effectiveness of BT-OAT.<br />Results: BT-OAT is not cost-effective relative to OAT over a 5-year time horizon with an incremental cost-effectiveness ratio (ICER) of $US138 889 per QALY from the societal perspective and $US139 041 per QALY from the health system perspective. The cost-effectiveness of BT-OAT largely depends on a combination of the cost of the BT procedure and the cost of asthma-related hospitalizations and emergency department (ED) visits.<br />Conclusion: Based on established thresholds for cost-effectiveness, BT-OAT is not cost-effective compared with OAT in Singapore. Given its current clinical efficacy, BT-OAT is most likely to be cost-effective in a setting where the cost of BT procedure is low and costs of hospitalization and ED visits are high.<br /> (© 2017 Asian Pacific Society of Respirology.)
- Subjects :
- Asthma drug therapy
Cost-Benefit Analysis
Disease Progression
Emergency Service, Hospital economics
Female
Hospitalization economics
Humans
Markov Chains
Middle Aged
Quality-Adjusted Life Years
Singapore
Treatment Outcome
Asthma economics
Asthma therapy
Bronchial Thermoplasty economics
Health Care Costs
Subjects
Details
- Language :
- English
- ISSN :
- 1440-1843
- Volume :
- 22
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Respirology (Carlton, Vic.)
- Publication Type :
- Academic Journal
- Accession number :
- 28370985
- Full Text :
- https://doi.org/10.1111/resp.13027