The clinical, utility and economic benefits of securing minimal important difference in asthma control test using a novel tool: the a.b.o.v.e. asthma (achieving-better-outcomes-and-value-for- everybody-in-asthma)

Abstract

Introduction and objectives: Asthma accounts for an economic loss of €72 billion annually in the 28 countries of the European Union with a monetised value of DALYs cost of €38 billion. One of the key priorities in asthma management is achieving asthma control. It is crucial to understand whether providing a minimally clinical important difference (MID) of the asthma control test (ACT) score can bring better clinical, utility and economic outcomes.
Aim: To test whether the Achieving Better Outcomes and Value for Everybody in Asthma (A.B.O.V.E.- ASTHMA) intervention works and the MID of the ACT score can provide positive outcomes for the patient, payer, provider and policy maker.
Methods: Using the data obtained from the Italian Medicines Use Review (I-MUR) cluster randomised controlled trial (C-RCT) (2014-2015) involving 1,263 asthma patients and 283 pharmacists in Italy, we tested whether A.B.O.V.E.- ASTHMA was able to (1) link a clinical outcome (ACT score) to economic and utility dimensions; (2) secure a MID improvement in ACT and the outcomes attached in terms of cost savings for the healthcare provider and gains in health utility (% of being in perfect health).
Results: Data from the C-RCT showed that after receiving the A.B.O.V.E.- ASTHMA intervention, patients improved their asthma control, assessed by the ACT, shifting from not controlled (RED) towards partially controlled (YELLOW); and towards fully controlled group (GREEN). Asthma control in the vast majority of patients improved. The number of patients who were on MID target and reached the GREEN group ( ) at 3 and 6 months were 129 (15.8%) and 162 (19.9%) respectively. The overall annual cost savings per 1,000 patients attached to the shift towards the MID target was equal to: 346,012 euros (NHS) at 3 months and increased to 435,483 euros (NHS) at 6 months (see Table). Health utility gains were equal to 0.9 and 0.29 years in full health, respectively.
Conclusions: The evaluation of the MID of ACT score using the A.B.O.V.E.- ASTHMA intervention has provided positive clinical and economic results, therefore better outcomes for everybody