PRS24 - The Humanistic And Economic Impact Of Following Evidence-Based Asthma Controller Therapy: A Simulation Study

Abstract

To quantify the potential US societal benefits, in terms of health care costs and quality of life, of improving gaps in care by increasing compliance with guideline-driven asthma management relative to the current level of care (i.e. status quo) A Markov model of asthma was created to simulate the natural history of asthma and the potential impact of improved compliance to medications over a 20 year time horizon. The current state of asthma care (status quo) in terms of the proportion of individuals who receive regular, irregular, and no controller treatment, along with parameters representing the natural history of asthma, was estimated from the literature. Total costs, exacerbation rates, and quality-adjusted life years (QALY) of a status quo strategy was compared with a hypothetical situation in which each individual receives regular controller medications according to the current recommendations (ideal strategy). All costs and outcomes were discounted at a rate of 0.02. Under the status quo, each individual with asthma will generate, on average, US $9681 in total medical costs and 14.3 QALYs over 20 years. By following guidelines, average total costs will increase to $18,446 producing 14.6 QALYs. The discounted number of exacerbations over 20 years for the status quoand optimal strategies will be 10 and 4.6, respectively. The incremental cost-effectiveness ratio (ICER) of the ideal strategy compared to status quo was estimated to be $29,217 US per QALY gained. There is a significant opportunity to reduce the socio economic burden of asthma in the US with greater adherence to evidence-based asthma management guidelines. While improved adherence to guidelines increases some costs (e.g. medications), the substantial return on investment associated with improved adherence will likely offset the extra costs.