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Kosten-Nutzen-Untersuchungen bei ambulanten Schulungsmassnahmen fur asthmakranke Kinder und ihre Familien [Cost-effectiveness studies of ambulatory educational programs for children with asthma and their families] |
Scholtz W, Haubrock M, Lob-Corzilius T, Gebert N, Wahn U, Szczepanski R |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Training programmes for asthmatic children.
Economic study type Cost-benefit analysis and cost-effectiveness analysis.
Study population Asthmatic children from Osnabruck as well as Berlinandenburg, Germany.
Setting Primary care in Osnabruck and Berlin/Brandenburg.
Dates to which data relate The health related and cost data were collected between 1993 and 1996.
Source of effectiveness data The data were extracted from a single study.
Link between effectiveness and cost data The costing was carried out on the same study sample as that used in the benefit/effectiveness analysis. Costs were first collected retrospectively during the year before training; once the training was undertaken, costs were recorded prospectively during the year after training.
Study sample No power calculations were reported. A total of 142 children were evaluated, but data for the cost-benefit analysis could only be considered from 53 out of 94 children from Osnabruck. No figure was given for the number of observations used in the cost-effectiveness analysis.
Study design A before-and-after multi-centre study was conducted for the cost benefit analysis with a duration offollow up of one year. No loss to follow up was reported. The effectiveness analysis employed a comparator group based on data published by Nowak, which found that non-trained asthmatics improve at half the rate in non-monetary criteria in comparison with trained asthmatics.
Analysis of effectiveness The following measures were chosen to assess the outcomes of the study: number of stationary in-hospitalisations, number of visits to a doctor due to mild asthmatic attacks, number of visits to a doctor due to strong asthmatic attacks, number of repeated asthma attacks and absence from school. The change in the number of occurrences of each measure was then weighted and valued to receive an effectiveness factor. The sum of all effectiveness factors was the total effectiveness factor, where a higher value stands for higher effectiveness reflecting an improvement in children's quality of life.
Effectiveness results Children who had undergone a test showed better improvement after a 10 hour training session with a total effectiveness factor of 4.75, compared with 3.05 for children who had not been trained. These two figures are the sum of the individual effectiveness factors for each group. For the amount of hospitalisation, non-trained patients had an effectiveness factor of 0.3, the same as patients with training. Doctors' visits due to mild attacks had factors of 0.6 and 0.9 for non-trained and trained children respectively, while doctor's visits linked to strong asthmatic attacks had effectiveness factors of 0.4 and 0.6 respectively. The number of asthmatic attacks for patients without training resulted in an effectiveness factor of 1.0 compared with 1.60 for trained children. Finally, absence from school accounted for an effectiveness factor of 0.75 for the non-trained and 1.35 for trained asthmatic children.
Clinical conclusions The effectiveness data clearly favour a training programme for asthmatic children when considering their quality of life.
Measure of benefits used in the economic analysis For the cost-benefit analysis the authors used monetary benefits, i.e., savingsin treatment cost per patient. The cost-effectiveness analysis used the total effectiveness coefficient as a measure of benefits.
Direct costs The cost of treatment was derived from practice records and included the cost for stationary hospitalisation, cost for doctor's visit due to light and severe asthmatic occurrence as well as cost for medication. The cost for a 10 hour ambulant training course included fees for the training team as well as investment and transport costs.
Statistical analysis of costs Estimated benefits used in the economic analysis In the first year after training, treatment costs per child decreased by DM320. The total effectiveness factors were 3.05 for patients without training and 4.75 for trained patients.
Cost results Costs were not discounted. Treatment cost per child was DM1,188 before ambulant training and DM868 in the year after. The cost of a 10 hour training session was stated to be DM526 per child (considering 6 participating families). Thus, the total cost per trained child in the first year was DM1,394.
Synthesis of costs and benefits Cost-benefit analysis:A comparison of costs and savings due to ambulant training showed that the net costs per child after training was DM1,074 (total cost-savings due to training),compared with DM1,188 before training. The difference of DM114 is the net benefit per year resulting from training. Even though the total cost of treatment and training in the first year exceeds the savings, they will eventually compensate the initial cost of training.
Cost effectiveness analysis:The cost-effectiveness ratio for ambulant training was DM1,394/4.75 or DM293 per unit of effectiveness, while the cost-effectiveness ratio without training was DM1,188/3.05 or DM390 per unit of effectiveness. Therefore ambulant training causes savings of DM97 per unit of effectiveness.
Authors' conclusions The authors concluded that cost-benefit analysis as well as cost-effectiveness analysis showed that ambulant training for asthmatic children lowered treatment costs as well as increasing the quality of life for each child in terms of effectiveness.
CRD COMMENTARY - Selection of comparators The rationale for the selection of comparators was clear. Validity of estimate of measure of benefit The authors do not go into detail as to how different factors of effectiveness were weighted and how exactly they arrived at individual results. However, they clearly state how the monetary benefits were derived in terms of savings. Validity of estimate of costs The costs were collected over a period of over 2 years, but were not discounted. Indirect costs were not accounted for, although they may have been relevant to the study. Other issues As outlined above, the authors used a comparator group derived from the literature, which may have introduced biases arising from a potential lack of comparability between the two groups. The effectiveness results should therefore be considered with a degree of caution. Implications of the study The study showed that ambulant training for the prevention of asthma is recommendable in monetary as well as in non-monetary terms. Source of funding Robert-Bosch foundation, Stuttgart and working party of the Gesetzliche Krankenversicherung Osnabrueck
Bibliographic details Scholtz W, Haubrock M, Lob-Corzilius T, Gebert N, Wahn U, Szczepanski R. Kosten-Nutzen-Untersuchungen bei ambulanten Schulungsmassnahmen fur asthmakranke Kinder und ihre Familien. [Cost-effectiveness studies of ambulatory educational programs for children with asthma and their families] Pneumologie 1996; 50(8): 538-543 Indexing Status Subject indexing assigned by NLM MeSH Adult; Ambulatory Care /economics; Asthma /economics /rehabilitation; Child; Cost-Benefit Analysis; Female; Germany; Humans; Male; Patient Care Team /economics; Patient Education as Topic /economics; Quality of Life AccessionNumber 21997006374 Date bibliographic record published 31/07/1999 Date abstract record published 31/07/1999 |
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