Page 142 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma
P. 142
Chapter 9
Abstract
Background: Feasibility of telemanagement has been widely demonstrated but there is still controversy about efficacy and cost effectiveness. Low adherence to the telemanagement strategy could impair health outcomes and increase health related costs, in particular in complex chronic diseases such as severe asthma.
Objectives: To investigate in patients with severe asthma whether adherence to an internet based monitoring system influences a) health outcome, defined as the reduction in medication use (prednisone) and b) costs related to medical consumption.
Methods: Data from 43 patients (19 male, 50.1 ± 11.2 (mean ±SD) year) with severe prednisone-dependent asthma were included in a secondary analysis of a prospective cohort study evaluating an internet-based prednisone tapering strategy. The telemanagement strategy included daily home-measurements of fractional exhaled nitric oxide (FeNO), a biomarker of asthma, which were then entered into the website by the patient. Adherence to the telemanagement strategy was calculated as the number of true measurements stored in the FeNO-analyser versus the per-protocol expected measurements. Healthcare costs included contacts with health care professionals and costs related to severe exacerbations. Linear regression analysis was used.
Results: Adherence rates were positively associated with the spared dose of prednisone over 6 months (r=0.51, p=0.001) and inversely associated with costs related to consultations with the general practitioner (b=-0.46, p=0.003), nurse (b=
-0.55, p =0.004) and chest physician (b=-0.41, p =0.03) as well as overall costs related to medical consumption (b=-0.39, p =0.03).
Conclusions and clinical relevance: High adherence to an internet self- management program is associated with better health outcomes and is cost saving. Efforts to improve adherence to telemanagement strategies may positively influence cost-effectiveness, in particular in patients with complex chronic diseases.
140
