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Disease Management & Health Outcomes

, Volume 15, Issue 6, pp 387–396 | Cite as

Cost-Effectiveness Analysis of a Pharmacy Asthma Care Program in Australia

  • Adam Gordois
  • Carol Armour
  • Martha Brillant
  • Sinthia Bosnic-Anticevich
  • Deborah Burton
  • Lynne Emmerton
  • Ines Krass
  • Bandana Saini
  • Lorraine Smith
  • Kay Stewart
Original Research Article

Abstract

Objectives

A pharmacy asthma care program in Australia, which included specific education on asthma and asthma medication, trigger factors, use of inhalers, and medication adherence, as well as goal setting and patient review aspects, assessed the impact of a community pharmacy asthma service on the severity of patients’ asthma over 6 months. Data from this study were used to estimate the cost effectiveness of the program.

Methods

The intervention population was compared with a control population and results at 6 months were included in a Markov model in order to estimate the cost effectiveness over 5 years from the perspective of the Australian healthcare system. The model had a cycle length of 6 months and included transition probabilities for switching between classes of severity of asthma, the costs of asthma treatment and program delivery, and utility values for a patient’s quality of life with asthma. Costs were Australian dollars ($A), year 2006 values, and both costs and benefits were discounted at a rate of 5% per annum.

Results

Over the 5 years following an initial review, the program generated 0.131 additional quality-adjusted life-years (QALYs), at an additional net cost of $A623 if annual reviews were required to maintain asthma improvements (annual review scenario) or $A376 if annual reviews were not required (no annual review scenario), resulting in costs per QALY gained of $A4753 and $A2869, respectively.

Conclusions

The program appears to be cost effective compared with no program, whether or not annual reviews were required to maintain improvements and under a range of other assumptions. Current evidence suggests that the pharmacy asthma care program should be implemented and funded for the treatment of adults with asthma in Australia.

Keywords

Asthma Severe Asthma Asthma Medication Mild Asthma Moderate Asthma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors would like to acknowledge Mr Fred Zmudzki for his assistance in constructing the economic model.

This work would not have been possible without the group of pharmacy practice respiratory researchers from across the nation working together; they and the pharmacists who joined in the vision are the reason this project was such a success.

This work was funded by the Australian Department of Health and Ageing as part of the 3rd community pharmacy agreement. The funding source had no part in the design or reporting of the study.

The authors have no conflicts of interest that are directly relevant to the content of this study.

References

  1. 1.
    Australian Bureau of Statistics. National health survey: summary of results, 2004–2005. Catalogue no. 4364.0. Canberra (ACT): Australian Bureau of Statistics, 2006Google Scholar
  2. 2.
    Australian Institute of Health and Welfare. Australia’s health. No. 9. Canberra (ACT): AIHW, 2004Google Scholar
  3. 3.
    Australian Institute of Health and Welfare. Australian Centre for Asthma Monitoring 2005: asthma in Australia 2005. AIHW Asthma Series 2, AIHW cat. no. ACM 6. Canberra (ACT): AIHW, 2005Google Scholar
  4. 4.
    Mathers CD, Vos ET, Stevenson CE, et al. The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors. Med J Aust 2000; 172: 592–6PubMedGoogle Scholar
  5. 5.
    Wilson DH, Adams RJ, Appleton SL, et al. Prevalence of asthma and asthma action plans in South Australia: population surveys from 1990–2001. Med J Aust 2003; 178: 483–5PubMedGoogle Scholar
  6. 6.
    Armour C, Bosnic-Anticevich S, Brillant M, et al. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax 2007; 62(6): 496–502PubMedCrossRefGoogle Scholar
  7. 7.
    Hawthorne G, Richardson J, Osborne R. The assessment of quality of life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 1999; 8: 209–24PubMedCrossRefGoogle Scholar
  8. 8.
    Briggs A, Sculpher M. An introduction to Markov modeling for economic evaluation. Pharmacoeconomics 1998; 13: 397–409PubMedCrossRefGoogle Scholar
  9. 9.
    Asthma Management Handbook. 5th ed. Melbourne: National Asthma Council of Australia, 2002 [online]. Available from URL: http://www.nationalasthma.org.au/publications/amh/amhcont.htm [Accessed 2006 Aug 1]
  10. 10.
    Blumenschein K, Johannesson M. Relationship between quality of life instruments, health state utilities, and willingness to pay in patients with asthma. Ann Allergy Asthma Immunol 1998; 80: 189–94PubMedCrossRefGoogle Scholar
  11. 11.
    Australian Government, Department of Health and Ageing. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee including major submissions involving economic analyses. Canberra (ACT): Australian Government, Department of Health and Ageing, 2002Google Scholar
  12. 12.
    Australian Bureau of Statistics. Life tables, Australia 2002–2004. ABS Cat. no 3302.0.55.001. Canberra (ACT): Australian Bureau of Statistics, 2004Google Scholar
  13. 13.
    Australian Government, Department of Health and Ageing. Schedule of pharmaceutical benefits from 1 December 2006. Canberra (ACT): Australian Government, Department of Health and Ageing, 2006Google Scholar
  14. 14.
    Australian Government, Department of Health and Ageing. Medicare benefits schedule effective 1 August 2006. Canberra (ACT): Australian Government, Department of Health and Ageing, 2006Google Scholar
  15. 15.
    Australian Government, Department of Health and Ageing. Public sector estimated round 9 (2004–2005) AR-DRG 4.2 cost report. Canberra (ACT): Australian Government, Department of Health and Ageing, 2006Google Scholar
  16. 16.
    Australian Government, Department of Health and Ageing. Manual of resource items and their associated costs. Canberra (ACT): Australian Government, Department of Health and Ageing, 2002Google Scholar
  17. 17.
    Australian Institute of Health and Welfare. Health expenditure Australia: 2004–2005. AIHW cat. no. HWE 35. Canberra (ACT): AIHW, 2006Google Scholar
  18. 18.
    World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2006. Oslo: Norwegian Institute of Public Health [online]. Available from URL: http://www.whocc.no/atcddd/indexdatabase/ [Accessed 2006 Jun 1]
  19. 19.
    George B, Harris A, Mitchell A. Cost-effectiveness analysis and the consistency of decision making: evidence from pharmaceutical reimbursement in Australia (1991 to 1996). Pharmacoeconomics 2001; 19: 1103–9PubMedCrossRefGoogle Scholar
  20. 20.
    Saini B, Krass I, Armour C. Development, implementation, and evaluation of a community pharmacy-based asthma care model. Ann Pharmacother 2004; 38: 1954–60PubMedCrossRefGoogle Scholar
  21. 21.
    Nishiyama T, Chrystyn H. The Jones Morbidity Index as an aid for community pharmacists to identify poor asthma control during the dispensing process. Int J Pharm Pract 2003; 11: 41–6CrossRefGoogle Scholar
  22. 22.
    Global Initiative for Asthma [online]. Available from URL: http://www.ginasthma.com [Accessed 2007 Oct 16]

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Adam Gordois
    • 1
  • Carol Armour
    • 2
  • Martha Brillant
    • 2
  • Sinthia Bosnic-Anticevich
    • 2
  • Deborah Burton
    • 3
  • Lynne Emmerton
    • 4
  • Ines Krass
    • 2
  • Bandana Saini
    • 2
  • Lorraine Smith
    • 2
  • Kay Stewart
    • 5
  1. 1.M-TAG Pty Ltd, a unit of IMS HealthSt Leonards, SydneyAustralia
  2. 2.Faculty of Pharmacy, Camperdown CampusThe University of SydneySydneyAustralia
  3. 3.School of Biomedical SciencesCharles Sturt UniversityOrangeAustralia
  4. 4.School of PharmacyThe University of QueenslandBrisbaneAustralia
  5. 5.Victorian College of PharmacyMonash UniversityMelbourneAustralia

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