When program costs (585€ in the IEP group) are compared to the average cost-of-illness level among study individuals at baseline (approximately 1,200€ per annum in the IEP group), it is not surprising that cost savings did not exceed program costs in the entire study population within the first year after intervention. But given the significant decline in morbidity costs, it can be assumed that a break-even for the entire study population might be arrived at in the subsequent year. In the light of evidence generated in earlier studies that demonstrated that patient education programs yield further cost savings in the long term, it is conceivable that this might also be true for the SPMP (plus IEP). Nevertheless, this assumption will need to be established empirically.
As our findings are based on the PPP, which is likely to represent the most compliant and motivated patients, we reckon that our results might be too optimistic. This is underlined by the results calculated for the population ITT. After replacing missing values by the group-specific averages, lower benefit-cost ratios were observed for the ITT population. Link
Noncompleters in the two intervention groups were characterized by significantly higher initial morbidity costs at baseline assessment when compared to study completers. Although scope for improvement was higher among these noncompleters, the education programs did not turn out to be as effective in these patients. Consequently, it will be of importance to develop strategies that will improve asthma management and compliance for these target groups.
The majority of patients enrolled in this study (65.2%) received inhaled steroids at baseline assessment. In contrast, earlier findings showed substantial underuse of inhaled steroids in patients with asthma in Germany. According to Lagerlov et al, only 31% of all asthmatic patients received inhaled steroids in a German study sample. An analysis from Maziak and colleagues proved that even among children with diagnosed asthma and > 12 wheezing attacks in the preceding year, only 42% had used inhaled steroids and only 21% reported regular use. As prescription of inhaled steroids to children with persistent symptoms is considered an important indicator of good adherence to asthma treatment guidelines, it can be assumed that the investigators in this study represent a positive selection of physicians fostering the need for antiinflammatory therapy as recommended.