Assessing cost-effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies.

Expenditures for medical care services continue to rise as a proportion of the total Gross Domestic Product (GDP) in most countries. Because a large share of resources are increasingly being spent on medical care services, there is a need to more closely examine the quality, cost and efficiency of all aspects of health care delivery. One method for assessing efficiency is cost-effectiveness analysis. Many of the elements of a basic cost-effectiveness model for asthma care are available, including accepted relevant studies on societal cost-of-illness, accepted health outcomes relevant to good clinical care, and a selection of potential intervention strategies, both for prevention and control. The purpose of this paper is to illustrate how an economic approach to decision-making can be used to assess the potential impact of alternative intervention strategies for asthma care. Two case studies are developed including a new management strategy for the chronic care of stable moderate asthma and a management strategy for the early detection and prevention of childhood asthma. It is proposed that economic modeling of possible intervention strategies can serve as a useful method for determining the potential impact (in terms of cost-effectiveness) of a proposed intervention strategy well in advance of any empiric clinical trials. Analysis such as these may prove valuable in protecting researchers from developing intervention strategies that are clinically efficacious but cost-ineffective and, therefore, are unlikely to be adopted by providers/payers of medical care services for asthmatics.