OBJECTIVES:

Two guidelines for the management of people with asthma are available in the UK, the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE). However, only NICE reviewed the health economic evidence. Differences between the two guidelines’ recommendations raise further issues when it comes to choosing value for money interventions. The aim of this article is to propose a cost-effectiveness value pyramid of asthma interventions in the UK guided by the available cost-utility evidence.

METHODS:

We followed a three-stage approach. Firstly, a systematic review identified cost-utility studies in asthma management. Secondly, the review was extended to cost-utility studies of interventions recommended by BTS/SIGN and NICE in wider patient populations. The results were then ranked as per value pyramids presenting the available evidence on cost-effectiveness of asthma interventions in UK separately for adolescents/adults (12+ years old) and children (6-14 years old).

RESULTS:

The most cost-effective treatments or interventions were: smoking cessation interventions and services (ICER £13 - £3,601/QALY) and flu vaccination (£2,996-£3,158 in adults and£2,294 - £4,751 in children), outpatient asthma clinic (£1,378-£6,776), specific subcutaneous immunotherapy (£6,975 in both adults/children), ICS+LABA combination inhaler (£7,604 - £13,706), and temperature-controlled laminar airflow devices (£8,915 in both adults/children). Several treatment options recommended for asthma management by BTS and/or NICE were not included in the pyramids in absence of any economic evidence.

CONCLUSIONS:

Lack of cost-effectiveness evidence leads to possible confusion when choosing asthma interventions providing the most benefits in terms of incremental health benefits per additional Pound spent. While our proposed study provides more guidance in this respect, we have also identified several gaps in the cost-effectiveness evidence. Future studies should focus on assessing cost-effectiveness of interventions like SABAs, theophylline, oral steroids, immunosuppressant, bronchial thermoplasty, allergy avoidance, exercise and other therapies where evidence is missing.