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(Correcting) misdiagnoses of asthma: a cost effectiveness analysis.

Pakhale S, Sumner A, Coyle D, Vandemheen K, Aaron S - BMC Pulm Med (2011)

Bottom Line: Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects.Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Ottawa, and The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada. spakhale@ohri.ca

ABSTRACT

Background: The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common.

Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective.

Method: Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.

Results: Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278).

Conclusion: Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

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Related in: MedlinePlus

Serial asthma testing algorithm (Confirmed Asthma = 346, Asthma excluded = 150) (PC20 - the provocation concentration that caused decrease in forced expiratory volume in 1 second (FEV1) of 20%).
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Figure 1: Serial asthma testing algorithm (Confirmed Asthma = 346, Asthma excluded = 150) (PC20 - the provocation concentration that caused decrease in forced expiratory volume in 1 second (FEV1) of 20%).

Mentions: The present cost-effectiveness analysis is based upon data from the asthma misdiagnosis longitudinal study involving normal weight and obese physician-diagnosed asthmatic subjects [7]. In this study, individuals who reported a physician diagnosis of current asthma were randomly selected from eight metropolitan areas of Canada through random-digit dialing. Subjects with > 10 pack year history of smoking were excluded in order to prevent enrollment of patients with chronic obstructive pulmonary disease (COPD). The individuals then underwent a series of lung function tests and a diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms, reversible airflow obstruction or bronchial hyperresponsiveness, despite being weaned off asthma medications. Asthma medications were stopped in those in whom a diagnosis of asthma was excluded and their clinical outcomes were assessed over a 6 month period prospectively. Further details of the study design, subject recruitment, and methods are described elsewhere [7]. The asthma diagnostic algorithm used in the study [7] is presented in figure 1. The study was approved by the research ethics boards of the 8 participating study hospitals; economic analysis was part of the ethics application. All patients who participated in the study gave written informed consent.


(Correcting) misdiagnoses of asthma: a cost effectiveness analysis.

Pakhale S, Sumner A, Coyle D, Vandemheen K, Aaron S - BMC Pulm Med (2011)

Serial asthma testing algorithm (Confirmed Asthma = 346, Asthma excluded = 150) (PC20 - the provocation concentration that caused decrease in forced expiratory volume in 1 second (FEV1) of 20%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118954&req=5

Figure 1: Serial asthma testing algorithm (Confirmed Asthma = 346, Asthma excluded = 150) (PC20 - the provocation concentration that caused decrease in forced expiratory volume in 1 second (FEV1) of 20%).
Mentions: The present cost-effectiveness analysis is based upon data from the asthma misdiagnosis longitudinal study involving normal weight and obese physician-diagnosed asthmatic subjects [7]. In this study, individuals who reported a physician diagnosis of current asthma were randomly selected from eight metropolitan areas of Canada through random-digit dialing. Subjects with > 10 pack year history of smoking were excluded in order to prevent enrollment of patients with chronic obstructive pulmonary disease (COPD). The individuals then underwent a series of lung function tests and a diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms, reversible airflow obstruction or bronchial hyperresponsiveness, despite being weaned off asthma medications. Asthma medications were stopped in those in whom a diagnosis of asthma was excluded and their clinical outcomes were assessed over a 6 month period prospectively. Further details of the study design, subject recruitment, and methods are described elsewhere [7]. The asthma diagnostic algorithm used in the study [7] is presented in figure 1. The study was approved by the research ethics boards of the 8 participating study hospitals; economic analysis was part of the ethics application. All patients who participated in the study gave written informed consent.

Bottom Line: Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects.Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Ottawa, and The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada. spakhale@ohri.ca

ABSTRACT

Background: The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common.

Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective.

Method: Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars.

Results: Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278).

Conclusion: Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

Show MeSH
Related in: MedlinePlus