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Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model

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Abstract

Background

Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework.

Methods

A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses.

Results

The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of €8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was €291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children.

Conclusion

This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.

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Acknowledgments

The authors appreciate the time and effort put into the study by the general practitioners from the Nijmegen Monitoring Project (NMP), the Regional Network of General practitioners (RNH), CEL and EXTRA, and their practice staff members to recruit participants and record and collect the required data. This study is funded by a grant (120610019) from the Netherlands Organisation for Health Research and Development (ZonMw).

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Authors and Affiliations

  1. Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    G. Feljandro P. Ramos, Sandra Kuiper, Tanja Maas, J. André Knottnerus & Onno C. P. van Schayck

  2. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Antoinette D. I. van Asselt

  3. Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Johan L. Severens

  4. Department of Paediatric Pulmonology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Edward Dompeling

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  1. G. Feljandro P. Ramos
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Correspondence to G. Feljandro P. Ramos.

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Ramos, G.F.P., van Asselt, A.D.I., Kuiper, S. et al. Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model. Eur J Health Econ 15, 869–883 (2014). https://doi.org/10.1007/s10198-013-0532-x

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  • DOI: https://doi.org/10.1007/s10198-013-0532-x

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