Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model

G.F.P. Ramos, A.D.I. van Asselt, S. Kuiper, J.L. Severens, T. Maas, E. Dompeling, J.A. Knottnerus, O.C.P. van Schayck

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

Abstract

Background Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework. Methods A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses. Results The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of (sic)8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was (sic)291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children. Conclusion This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.
Original languageEnglish
Pages (from-to)869-883
Number of pages15
JournalEuropean Journal of Health Economics
Volume15
Issue number8
DOIs
Publication statusPublished - Nov 2014

Keywords

  • Primary prevention
  • Asthma
  • Cost-effectiveness
  • Decision-analysis
  • ALLERGEN AVOIDANCE
  • CHILDHOOD ASTHMA
  • INTERVENTION PROGRAM
  • ECONOMIC-EVALUATION
  • CHILDREN
  • INFANCY
  • TRIAL
  • DESIGN
  • UNCERTAINTY
  • ATOPY

Cite this

@article{94e73b3f62954973b96c93add7766598,
title = "Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model",
abstract = "Background Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework. Methods A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses. Results The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of (sic)8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was (sic)291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children. Conclusion This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.",
keywords = "Primary prevention, Asthma, Cost-effectiveness, Decision-analysis, ALLERGEN AVOIDANCE, CHILDHOOD ASTHMA, INTERVENTION PROGRAM, ECONOMIC-EVALUATION, CHILDREN, INFANCY, TRIAL, DESIGN, UNCERTAINTY, ATOPY",
author = "G.F.P. Ramos and {van Asselt}, A.D.I. and S. Kuiper and J.L. Severens and T. Maas and E. Dompeling and J.A. Knottnerus and {van Schayck}, O.C.P.",
year = "2014",
month = "11",
doi = "10.1007/s10198-013-0532-x",
language = "English",
volume = "15",
pages = "869--883",
journal = "European Journal of Health Economics",
issn = "1618-7598",
publisher = "Springer",
number = "8",

}

Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model. / Ramos, G.F.P.; van Asselt, A.D.I.; Kuiper, S.; Severens, J.L.; Maas, T.; Dompeling, E.; Knottnerus, J.A.; van Schayck, O.C.P.

In: European Journal of Health Economics, Vol. 15, No. 8, 11.2014, p. 869-883.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model

AU - Ramos, G.F.P.

AU - van Asselt, A.D.I.

AU - Kuiper, S.

AU - Severens, J.L.

AU - Maas, T.

AU - Dompeling, E.

AU - Knottnerus, J.A.

AU - van Schayck, O.C.P.

PY - 2014/11

Y1 - 2014/11

N2 - Background Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework. Methods A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses. Results The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of (sic)8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was (sic)291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children. Conclusion This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.

AB - Background Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework. Methods A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses. Results The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of (sic)8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was (sic)291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children. Conclusion This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.

KW - Primary prevention

KW - Asthma

KW - Cost-effectiveness

KW - Decision-analysis

KW - ALLERGEN AVOIDANCE

KW - CHILDHOOD ASTHMA

KW - INTERVENTION PROGRAM

KW - ECONOMIC-EVALUATION

KW - CHILDREN

KW - INFANCY

KW - TRIAL

KW - DESIGN

KW - UNCERTAINTY

KW - ATOPY

U2 - 10.1007/s10198-013-0532-x

DO - 10.1007/s10198-013-0532-x

M3 - Article

VL - 15

SP - 869

EP - 883

JO - European Journal of Health Economics

JF - European Journal of Health Economics

SN - 1618-7598

IS - 8

ER -