Cost-effectiveness of telephone or surgery asthma reviews: Economic analysis of a randomised controlled trial

Background. Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review. Aim. To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews. Design of study. Cost-effectiveness analysis based on a 3-month randomised controlled trial. Setting. Four general practices in England. Method. Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation. Results. A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. One-hundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P<0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P<0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = £64.49 [SD = 73.33] versus surgery = £59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = £725.84 versus surgery = £755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = £7.19 [SD = 2.49] versus surgery = £11.11 [SD 3.50]; mean difference = -£3.92 [95% confidence interval = -£4.84 to £3.01], P<0.001). Conclusions. Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved. © British Journal of General Practice 2005.