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Preferences and utilities for the symptoms of moderate to severe allergic asthma

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Abstract

Introduction

Patients with moderate to severe allergic asthma have persistent poorly controlled asthma despite inhaled or systemic corticosteroid therapy. New therapies are becoming more widely available to treat such patients, but their value needs to be formally assessed in an economic evaluation. Within a publicly funded health care system such an analysis should reflect societal preferences when measuring treatment benefits. The aim of this study was to elicit societal preferences for the symptom burden associated with moderate to severe allergic asthma.

Method

Existing daily symptom diary data from a clinical trial were used to develop health state descriptions for evaluation in a standard gamble interview. Five health states were produced that reflected five distinct levels of control ranging from ‘complete control of asthma’ to ‘worsening of asthma’, as defined by another outcome measure. The symptom diary data were also used as attributes in a discrete choice experiment (DCE) to estimate willingness to pay for improvements in symptoms. Members of the general public (n = 101) completed the interview.

Results

Thirteen participants failed the consistency checks and were excluded from the analysis. Societal utility ratings for the health states ranged from 0.71 (worsening of asthma) to 0.78 (complete control of asthma). The participants were also willing to pay £160 a month for the avoidance of all symptoms.

Conclusions

The range of utility values (0.71–0.78) demonstrates the severity of moderate to severe allergic asthma. However the spread of scores between complete control of asthma and worsening of asthma was lower than was expected. The community sample placed only a moderate value on the avoidance of all asthma symptoms in the DCE survey. The results suggest that the community sample may not have fully understood the benefits of control over asthma symptoms and the limitations such symptoms can impose on everyday life.

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Acknowledgments

The authors would like to acknowledge the assistance of Bernadette Khoshaba who helped to develop the health states and interviewed some study participants. The study was funded by Novartis AG.

Author information

Authors and Affiliations

  1. Oxford Outcomes Ltd, West Way, Oxford, OX2 0JJ, UK

    Andrew Lloyd

  2. United BioSource Corporation, 20 Bloomsbury Square, London, WC1A 2NS, UK

    Scott Doyle & Sarah Dewilde

  3. Novartis AG, Basel, Switzerland

    Florian Turk

Authors
  1. Andrew Lloyd
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  2. Scott Doyle
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  3. Sarah Dewilde
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  4. Florian Turk
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Corresponding author

Correspondence to Andrew Lloyd.

Appendices

Appendix 1

Complete control of asthma

Table 6  
Full size table

Marked improvement of asthma

Table 7  
Full size table

Discernible, but limited improvement in asthma

Table 8  
Full size table

No appreciable change in asthma

Table 9  
Full size table

Worsening of asthma

Table 10  
Full size table

Appendix 2: attributes and levels from DCE

Morning asthma symptoms

  • Each morning when you wake up you did not have any asthma symptoms (such as chest tightness, wheezing or cough).

  • Each morning when you wake up you have asthma symptoms (such as chest tightness, wheezing or cough).

Nighttime breathing problems

You may experience breathing problems at night. These normally include chest discomfort (tightness), wheezing, and cough, and possibly shortness of breath.

  • You did not wake up because of any breathing problems.

  • You wake up once a night because of breathing problems but did not need to use your inhaler.

  • You wake up once because of breathing problems, but you used your inhaler to control the symptoms.

  • You awoke more than once because of breathing problems, but you used your inhaler to control the symptoms.

Daytime asthma symptoms

You may experience asthma symptoms during the day. These include—shortness of breath (breathlessness), chest discomfort (tightness), wheezing, and cough.

  • You have no symptoms at all; unrestricted activity.

  • You have some symptoms which caused little or no discomfort; unrestricted activity.

  • You have symptoms which cause some discomfort, at times limiting strenuous activity.

  • You have symptoms which cause moderate discomfort and sometimes limited routine activity.

Cost

You would have to pay for your new asthma medication out of you pocket. Think about whether you could afford the price and whether you would be willing to pay.

  • Cost is £20 per month

  • Cost is £40 per month

  • Cost is £60 per month

  • Cost is £80 per month

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Lloyd, A., Doyle, S., Dewilde, S. et al. Preferences and utilities for the symptoms of moderate to severe allergic asthma. Eur J Health Econ 9, 275–284 (2008). https://doi.org/10.1007/s10198-007-0075-0

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  • DOI: https://doi.org/10.1007/s10198-007-0075-0

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