Asthma cost-effectiveness analyses: Are we using the recommended outcomes in estimating value?

Background: Common to the gap that exists in other cost-effectiveness analyses (CEAs), asthma medication CEAs lack the qualitative assessment regarding whether they are capturing the appropriate outcomes necessary to provide robust judgement regarding the value of the interventions being compared. We aim to assess the type of outcomes in asthma medication CEAs, published between 2010-2015 and recommend a direction for improvement of future studies. Methods: We performed a systematic search in PubMed, EMBASE, Tufts CEA registry, Cochrane, and NHSEED from January 2010-December 2015. Keywords included 1) cost effectiveness, cost utility, economic evaluation, health economics, or cost benefit AND 2) asthma. All CEA studies evaluating ≥1asthma medication were included. Authors assessed each study with respect to asthma-specific health outcome recommendations sponsored by The National Institute for Health (NIH) including: core (hospitalizations, ED visits, outpatient visits, medication, interventions costs), supplemental (visit categories and work/school absence), and emerging (academic/job-related) asthma outcomes. Limitations of each CEA were also thematically summarized. Results: A total of 26 CEAs were included. Only 12 (46.2%) of the 26 studies included all of the core outcomes, 7 (26.9%) included asthma-specific outpatient visit categories, 6 (23.1%) included asthma school or work absences, 5 (19.2%) included respiratory healthcare use, and none of the studies included emerging outcomes. Conclusion: There are major gaps in use of recommended asthma outcomes. These findings call for appropriate use of recommended outcomes in order to better estimate the true value of asthma interventions