Long-term economic evaluation of intensive patient education during the first treatment year in newly diagnosed adult asthma

The cost-effectiveness of intensive patient education of guided asthma self -management given during the first treatment year was evaluated after 5 yea rs of follow-up. Consecutive, newly-diagnosed asthmatics (n = 162, age 18-7 6 years) were randomized for intensive (80 patients) vs. conventional patie nt education. Effectiveness was evaluated in terms of lung functions, airwa y hyperresponsiveness (PD15), and quality of life as measured by the generi c 15D and disease-specific St. George's Respiratory Questionnaire (SGRQ). T otal treatment costs were also estimated. All patients had anti-inflammator y treatment from the beginning. Sixty-four intervention group OG patients a nd 70 control group (CG) patients were evaluated after 5 years. Forced resp iratory volume in 1 sec (FEV1) improved only in the IG; and only during the first treatment year. However, PD15 improved throughout the followup. The unscheduled healthcare rests were significantly higher in the CG than in th e IG (P = 0.04) and the relative risk for sickness days due to asthma was l ower in the IG than in the CG, odds ratio 0.33 (95% CI 0.28; 0.40). However . because there was no significant difference between the groups in any out come variable or in total costs at 5 years, the incremental cost-effectiven ess ratio could not be calculated. The first year intervention had only a s hortterm beneficial treatment effect, which the CG could catch up during th e two last follow-up years, except in FEV1. The peak expiratory flow (PEF)- based self-management had no advantage over the symptom-based self manageme nt. However, the intervention had a consistent tendency of being less costl y in the long-run. It is possible to conclude tentatively that regular effe ctive medical treatment and control visits during the first treatment year is at least as important for the long-term treatment result as intensive pa tient education.