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 pound [SD = 73.33] versus surgery = 59.48 pound [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 pound versus surgery = 755.70) pound, but mean cost per consultation achieved was lower in the telephone arm (telephone 7.19 pound [SD = 2.49] versus surgery = 11.11 pound [SD = 3.50]; mean difference = -3.92 pound [95% confidence interval = -4.84 pound to 3.01] pound, 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.