Long-term (3-year) economic evaluation of intensive patient education for self-management during the first year in new asthmatics

Patient education and self-management programmes have proved effective in m any studies with short follow-up periods, We studied the 3-year cost-effect iveness of an intensive programme of patient education and supervision for self-management. The study consisted of 162 consecutive newly diagnosed asthmatics who were randomized either into an intervention group (IG) receiving intensive patie nt education and supervision for self-management at an outpatient clinic du ring the first year, or a control group (CG) receiving conventional educati on at the baseline visits only. Both groups had 2 additional years of follo w-up. Lung functions and health-related quality of life (HRQOL) were measur ed. Extra direct and indirect costs were recorded. At 3 years the differences in forced expiratory volume in 1 s (FEV1) and in peak expiratory flow (PEF) were significantly better in the IG being in (% predicted) respectively 5.3 (95% CI 0.6-10.0) and 4.4 (95% CI 0.1-8.7), (P <0.05). The airway responsiveness (PD,,) did not differ significantly, but the improvement from baseline to 3 years was significantly greater in the I G, being 0.40 dose steps (95% CI 0.05-0.75) (P<0.05). HRQOL scores did not differ significantly. The risk for sickness day was less in the IG with a R R of 0.6 (95% CI 0.50-0.69) (P=0.000) and among patients who used the PEF m eter. The compliance was similar in both groups when measured by the PEF-ba sed self-management. There was no statistically significant difference in c osts, although there was a consistent tendency for lower costs in the inten sive programme. The intensive programme was more effective in terms of FEV1, PEF and improv ement in PD15 and equally effective in terms of other lung functions and HR QOL, but there was no clear difference in the costs.