Is it cost-effective to prompt Australian parents to bring their children with asthma to the general practitioner for proactive review under the asthma 3+ visit plan?

Abstract

The aim of this project was to perform an economic evaluation of the implementation of the Asthma 3+ visit Plan in Australia, in parallel with a randomised controlled trial. The trial involved 24 GPs and 174 children aged 5-11 years with moderate to severe asthma, cluster-randomised into two groups by medical practice. The control group received usual asthma care, while the intervention group were reminded to attend by the researchers prompting practices to recall patients according to the recommended schedule. The evaluation focused on the marginal costs of promoting the Asthma 3+ Visit Plan to GPs and patients, and compared the costs with the economic consequences of the plan on attendance rates, use of other health services and use of medication. Analysis was done of the difference in costs of asthma care between the two groups over a twelve-month period. A societal perspective was taken, with both direct and indirect costs being considered as they impacted on general practitioners, other health providers, patients and their families. While there was a statistically significant increase in the number of asthma-related GP visits by those in the intervention group, there was no statistically significant difference in the total number of visits, nor in the associated travel and time costs for parents of the children. The number and cost of referrals to specialists and allied health professionals were lower for the intervention group, while the use and cost of diagnostic tests was higher, but neither were statistically significant. The proportion of patients incurring any medication costs was lower in the intervention group, with a reduced cost per patient. The costs to implement the plan averaged approximately $400 per GP, with the prompts to practices costing $100 per GP. This study suggests that the 3+ plan is cost-effective when implemented with children with asthma.