Page 109 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma
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                                Cost-effectiveness of telemanagement in asthma
Given current demographic challenges and costs of health care, novel cost- effective management strategies for asthma are required to face up to the global burden of asthma. To date, the cost-effectiveness of telemanagement interventions, including the cost of the technology and the user time is rarely reported. A cost-utility analysis of the study from Van Meer [24] showed that telemanagement can be as effective as current asthma care with regard to quality of life in terms of patient utilities and costs are similar over a one-year period [33]. However, the long term cost-effectiveness may be more favorable, since the major intervention costs for equipment and cost of education sessions apply to the first year, costs in later years may be reduced whilst the long-term effects observed during the first year may sustain. In addition, costs per patient will decrease if maintenance costs can be spread over an increasing number of users, thereby further improving the cost-effectiveness. Future long-term studies should include the costs for the ubiquitous technology upgrades and should focus on criteria such as which patients should have the telemanagement service and over what period of time in order to optimize outcomes.
Implementation of telemanagement in asthma care
Given the accumulating evidence on the effectiveness of telemanagement in asthma, we advocate the implementation of comprehensive telemanagement services in routine practice. This will also allow us to collect further information on costs and effects under real world circumstances. During the development and the implementation process itself, a focus should be kept on the end-users [34], therefore potential barriers and facilitators perceived by the end-users should be identified prior to implementation. A structured implementation strategy is needed to incorporate telemanagement in current clinical practice and into a patient’s daily life. Tailoring an implementation strategy to barriers and facilitators experienced by the target group (patients with asthma, nurses and physicians) is recommended [35]. Such barriers can be identified at different levels of the healthcare system: innovation, individual patient, professional level, societal context (i.e. opinion of colleagues), organizational
Telemanagement in asthma
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