Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study Zafar Zafari, BSc, MSc, Larry.

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Presentation transcript:

Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study Zafar Zafari, BSc, MSc, Larry D. Lynd, PhD, J. Mark FitzGerald, MD, Mohsen Sadatsafavi, MD, PhD Journal of Allergy and Clinical Immunology Volume 134, Issue 4, Pages 908-915.e3 (October 2014) DOI: 10.1016/j.jaci.2014.04.009 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Schematic illustration of the asthma Markov model. Journal of Allergy and Clinical Immunology 2014 134, 908-915.e3DOI: (10.1016/j.jaci.2014.04.009) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Changes in levels of control over 10 years. A, Status quo scenario. B, Full-adherence scenario. Exacerbation state was incorporated in the uncontrolled state in this figure. Journal of Allergy and Clinical Immunology 2014 134, 908-915.e3DOI: (10.1016/j.jaci.2014.04.009) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Results of 1-way sensitivity analyses. *In this sensitivity analysis we assume that partial adherence can have the same effect as full adherence in achieving asthma control. For instance, the lower bound of this sensitivity analysis means a 25% increase in current adherence levels is as good as full adherence. †Details of this sensitivity analysis are shown in Appendix E3. ‡Details of this sensitivity analysis are shown in Appendix E3. Journal of Allergy and Clinical Immunology 2014 134, 908-915.e3DOI: (10.1016/j.jaci.2014.04.009) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 A, Cost-effectiveness plane showing the scatterplot of the incremental costs and QALYs between the status quo and full-adherence scenarios. B, CEAC showing the probability of the full-adherence scenario being cost-effective as a function of WTP per an additional QALY. Journal of Allergy and Clinical Immunology 2014 134, 908-915.e3DOI: (10.1016/j.jaci.2014.04.009) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Results of the scenario analysis. The shaded area represents the cost-effective region for different programs' implementation costs and adherence improvement levels at a WTP value of $50,000/QALY (top panel) and $100,000/QALY (bottom panel). Adherence improvement is relative to the extent of the gap between status quo level of adherence and full adherence. For example, a 50% improvement means the level of adherence after implementing the program will be at the midpoint of adherence between the status quo and full-adherence scenarios within each stratum. Journal of Allergy and Clinical Immunology 2014 134, 908-915.e3DOI: (10.1016/j.jaci.2014.04.009) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions