Cost-effectiveness analysis of a state funded program for control of severe asthma

Programa para o Controle da Asma e da Rinite Alérgica na Bahia (ProAR), Faculdade de Medicina, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.
BMC Public Health (Impact Factor: 2.26). 02/2007; 7(1):82. DOI: 10.1186/1471-2458-7-82
Source: PubMed


Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce.
81 patients with severe asthma (12-75 years) joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted.
64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733.
A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.

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    • "Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387/patient (Table 1).42 "
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    ABSTRACT: The prevalence of asthma is increasing in developing countries and the burden of uncontrolled asthma affects patients, families, and the health system. This is to summarize, evaluate, and discuss previous reports on the impact of a targeted and comprehensive approach to the most severe cases of asthma in a low-income setting. A Program for Control of Asthma (ProAR) was developed in Salvador, Bahia, Brazil, prioritizing the control of severe asthma. By facilitating referrals from the public health system and providing proper multidisciplinary but simple management including education and medication, for free, the Program enrolled 2385 patients in 4 reference clinics. They are offered regular follow up and discharged back to primary health care only when asthma control can be maintained without requirement of a combination of an inhaled corticosteroid and a long-acting β2 agonist. ProAR has markedly reduced health resource utilization and decreased the rate of hospital admissions because of asthma in the entire City (2.8 million inhabitants) by 74%. Moderate to severe rhinitis was associated with lack of control of asthma. The average income of the families in the ProAR was US$2955 a year, and they spent 29% of all their income attempting to control the severe asthma of one member, a unbearable expenditure for a low-income family. The ProAR was shown to be cost-effective, reducing costs to the public health system (US$387 patient/year) and the families (US$789 patient/year). In a low-income setting of Brazil, an intervention prioritizing the control of severe asthma was feasible, effective, and reduced costs.
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    ABSTRACT: Asthma is a disease of high morbidity and and costs for the patients and the government. In Brazil asthma is the third cause of hospital admissions in public facilities. Adequate therapy can control symptoms, avoid hospitalizations and preventable deaths. Based upon these premises, programs to control asthma have been created in several cities, with substantial reduction in morbidity among subjects enrolled. In Brazil, there are some ongoing initiatives, but they are still isolated and focused in different age-groups and severity of asthma. The Program for Control of Asthma and Allergic Rhinitis in Bahia (ProAR) was launched in 2003, priorizing severe asthmas in four reference centers in Salvador. Preliminary analysis of patients enrolled in ProAR demonstrated marked reduction in health resource utilization and in families' and government costs, increasing in families' incomes and in patients' related quality of life. Another study, by populational analysis, identified a marked reduction in hospitalizations and in-hospital mortality due to asthma in Salvador after the
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