Browsing by Author "Morais, Francisca Diniz"
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- Literacy interventions in asthma – a cost-effectiveness study and a perspective in PortugalPublication . Morais, Francisca Diniz; Maricoto, Tiago João Pais; Taborda-Barata, LuísIntroduction Asthma is a chronic, non-communicable, respiratory disease which is estimated to affect up to 7% of the Portuguese population. Most patients are clinically uncontrolled, and that may be partially due to low health literacy. Several trials have tested the efficacy of literacy interventions on asthma outcomes, but their cost-effectiveness is still unclear. Objective To perform a cost-effectiveness analysis of literacy interventions in patients with asthma and estimate the cost-benefit of applying such a programme in Portugal. Perspective and Methods We developed a decision tree analysis from a healthcare perspective, according to several outcomes (poor clinical control, emergency department (ED) visits, hospitalisations, use of rescue medication) rates and costs described in previous clinical trials, and according to intervention costs. Sensitivity analysis of worst and best-case scenarios was performed to estimate thresholds for intervention affordable limits, as well as cost-saving estimations and Incremental Cost-Effectiveness Ratio (ICER) for a Portuguese scenario. Setting We estimated cost-effectiveness thresholds applicable in all settings and performed a sensitivity analysis of a theoretical intervention model in all patients, including literacy enhancement at an annual appointment with a doctor and a nurse. Results Data from 8 RCTs was included. In the best-case scenario, intervention affordable budget per patient per year were estimated at: 107,38€ to avoid one patient with poor clinical control, 3,20€ to avoid an ED visit, 10,35€ to avoid a hospitalisation and 1,13€ to avoid the use of rescue medication or OCS. Cost savings for Portuguese scenario were more pronounced to avoid poor clinical control, at 100,68€ per patient per year. ICER for Portugal were estimated for best-case scenarios at: poor clinical control 55,83€, ED visits 134,00€, hospitalisations 111,67€ and use of rescue medication or OCS 55,83€; each per outcome event avoided. Subgroup analysis show that for studies with 12-month follow-up and including mild to moderate asthma patients, the estimates for cost-effectiveness are more favourable to avoid poor clinical control, ED visits and hospitalisations. Conclusions Literacy interventions may be potentially cost-effective according to Portuguese costs and scenarios, although with a wide range of uncertainty. This is more pronounced in reducing the risk for poor clinical control, emergency room visits and hospitalisations, particularly in patients with mild to moderate asthma severity and with longer follow-up (12 months).