Abstract
BackgroundThe prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective.MethodRandomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.ResultsOf 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278).ConclusionCost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.
Highlights
The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common
Asthma diagnosis and medications Five-hundred and forty individuals with physician-diagnosed asthma entered into the study, 41 patients withdrew prematurely before study completion and three patients were categorized as ‘unable to classify’ because their baseline FEV1 was less than 60% predicted and they were unable to safely undergo a bronchial challenge test
We were able to exclude a diagnosis of asthma in 150 of the 540 subjects who entered into the study (28%; 95% Credible Intervals (CI): 19-37%)
Summary
The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective. Over the past 3 decades the prevalence of physician-diagnosed asthma has increased more than 75% in Canada and in the US [1,2]. Studies from Canada suggest that less than 50% of Canadians receive lung function testing before a diagnosis of asthma is assigned by their physician [3,4]. A recent study [7] by our group determined the proportion of obese and normal weight Canadian adults with an incorrect diagnosis of asthma. Subjects were randomly sampled from 8 cities across Canada by random
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