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Health economics of asthma and rhinitis. II. Assessing the value of interventions☆,☆☆,★

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Abstract

Health care providers and payers are being asked to weigh data on the economic impact of new interventions along with clinical evidence when making decisions about the care of patients. The notion of incorporating formal health economic assessments into clinical and resource decisions is a difficult concept for many in the health care sector. However, it is the reality in today’s environment. To effectively participate in these ongoing discussions, clinicians and other decision makers must be able to understand and critically assess the evidence on economic impact of medical interventions. This second of 2 articles describes the elements of comparative economic evaluations, reviewing the published literature on asthma and rhinitis in an attempt to critically appraise the studies from the perspective of one who might use data for decision making. Unfortunately, the quality of the economic evidence in these two disease states is not extensive. Until better economic analyses are conducted and made available, the allocation of resources for asthma and allergic rhinitis will continue to primarily rely on expert opinion rather than evidence-based literature. (J Allergy Clin Immunol 2001;107:203-10.)

Section snippets

Basic principles of CEA

CEA can be defined as a set of related methods to assess and quantify the costs and clinical consequences of medical care treatments to estimate the “economic value” of the intervention in relation to alternative treatments. These methods were described briefly in the first part of this review.3 A CEA of competing medical treatments should incorporate evidence on the clinical consequences (efficacy and safety) and the costs and relative cost-effectiveness of treatment alternatives.7, 8

Assessment of value in the care of persons with asthma and rhinitis

Following is a concise review of studies of both asthma and allergic rhinitis that highlight the utility of economic evaluations for clinical and resource decision making. Only a few of these studies have met recommended standards for economic evaluation.9, 10, 11 The review emphasizes studies that conform to appropriate scientific rigor but also points out notable studies that fail to meet guidelines. Also identified are important or contemporary interventions that lack even basic published

Conclusion

The health economic literature for asthma and rhinitis has evolved considerably during the past decade. CEA is now recognized as a standardized methodology for assisting decision makers in selecting and reimbursing health care interventions that maximize the health of populations, given the conflicts generated by constrained health budgets and the rising demand for medical care. Unfortunately, much of the literature in asthma and rhinitis, while evolving, does not currently meet accepted

Acknowledgements

We thank Ms Robin Wagner for her editorial assistance and Ms Josephine Diaz and Ms Monica Blumthal for their assistance with document retrieval.

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    ☆

    Supported by a grant from Astra Pharmaceuticals, Westborough, Mass

    ☆☆

    Supported in part by an educational grant from the Asthma and Allergy Foundation of America.

    ★

    Reprint requests: Kevin B. Weiss, MD, Director, Center for Health Services Research, Rush Primary Care Institute, Rush-Presbyterian-St Luke’s Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.

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