Repeatability of health economic data in COPD.

BACKGROUND: Little is known concerning the precision of self-reported health economic data. AIM: To investigate the repeatability of self-reported health economic cost and utilization data in subjects with chronic obstructive pulmonary disease (COPD). METHODS: Twelve weeks after inclusion, a physician and a nurse in random order interviewed 29 subjects with post-bronchodilator COPD included from a research registry of COPD patients. The interview recorded healthcare utilization and costs, sick leave, exacerbations and quality of life (QoL). Variation of individual agreement of observations was described estimating kappa statistics and 95% limits of agreement. RESULTS: Mean age was 63 years (standard deviation (SD) 10) and 17 participants were men. Average FEV(1)% predicted was 56% (SD 15). For sick leave, exacerbation, healthcare provider visit, change of medication, assistance and leisure time the kappa values were 1.00, 0.73, 0.73, 0.66, 0.63 and 0.54, respectively. The physician recorded fewer days of exacerbation and fewer contacts with healthcare providers than the nurse (p=0.01 and p=0.05, respectively). The 95% limits of agreement for costs of drugs were -690 to +710 Norwegian Kroner (NOK), -1200 to +899 NOK for costs of healthcare providers and -20 to +26 for QoL as measured by a visual analogue scale. CONCLUSION: Repeatability of economic data from COPD patients showed considerable variation. This issue should be addressed when analyzing cost data from interviews and when designing studies on health economy.

Exposure to environmental tobacco smoke in a general population.

AIMS: To estimate how the level of exposure to environmental tobacco smoke (ETS) in pregnancy, childhood and adulthood vary with personal characteristics in a general population. METHODS: In 1996/1997, a community sample of 3181 adults, aged 26-82, received a mailed questionnaire, to which 2819 subjects responded. The prevalences of ETS exposure were estimated according to sex, age, educational level, smoking, occupational dust or gas exposure and exposure to moulds. Logistic regression was used to estimate the adjusted odds ratios for the different ETS exposures with respect to these covariates. RESULTS: Altogether 9% reported exposure to maternal smoking in foetal life and 23% in childhood. Fourteen percent reported current domestic ETS exposure, while 13% reported current occupational ETS. Occupational ETS exposure was more frequent among men (16%) than women (10%). The oldest subjects (61-82 years) reported less ETS exposures than the younger subjects. Current smokers and subjects with occupational dust or fumes exposure had a higher prevalence for all the ETS exposures compared to ex- and never smokers and subjects without occupational exposure, respectively. CONCLUSION: From a general population sample male sex, younger age, current smoking, and occupational dust or fumes exposure were associated with higher level of ETS exposure.

Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease.

BACKGROUND: Smoking cessation is probably the most important action to reduce mortality after a coronary event. Smoking cessation programs are not widely implemented in patients with coronary heart disease, however, possibly because they are thought not to be worth their costs. Our objectives were to estimate the cost effectiveness of a smoking cessation program, and to compare it with other treatment modalities in cardiovascular medicine. METHODS: A cost-effectiveness analysis was performed on the basis of a recently conducted randomized smoking cessation intervention trial in patients admitted for coronary heart disease. The cost per life year gained by the smoking cessation program was derived from the resources necessary to implement the program, the number needed to treat to get one additional quitter from the program, and the years of life gained if quitting smoking. The cost effectiveness was estimated in a low-risk group (i.e. patients with stable coronary heart disease) and a high-risk group (i.e. patients after myocardial infarction or unstable angina), using survival data from previously published investigations, and with life-time extrapolation of the survival curves by survival function modeling. RESULTS: In a lifetime perspective, the incremental cost per year of life gained by the smoking cessation program was euro 280 and euro 110 in the low and high-risk group, respectively (2000 prices). These costs compare favorably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. CONCLUSIONS: A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease.

[The effect of patient education in asthma, a randomized controlled trial]. / Effekter av astmaopplaering i en randomisert, kontrollert undersøkelse.

BACKGROUND: Our aim was to evaluate costs and consequences of patient education in asthmatics in a twelve-month follow-up. MATERIAL AND METHODS: 78 asthmatics were randomly allocated to a control or intervention group after having received ordinary outpatient care. Intervention consisted of two two-hour group sessions followed by one or two individual sessions administered by a nurse and a physiotherapist. Self-management was emphasised. Visits to the doctor, prescribed drugs, hospital admissions, travel costs, time costs, and educational costs were recorded. RESULTS: In a twelve-month follow-up, patient education resulted in approximately a 70% reduction in GP visits and days off work due to asthma as well roughly a doubling of proportions with satisfactory steroid inhaler compliance compared to no education. Patient education also improved lung function (FEV1) by 6%, and it improved quality of life. The control and intervention groups had mean total costs of NOK16,000 and 10,500 per patient respectively. A 5% improvement in FEV1 in the intervention group was associated with savings of NOK 4,500 compared to the control group. The number needed to educate (NNE) to make one person symptom free was associated with savings of NOK 12,200. INTERPRETATION: Patient education in asthmatics in a twelve-month follow-up improved patient outcomes and reduced costs.