Background
Components | RMTAC | UC |
---|---|---|
Pharmacological management | • | |
Assess and monitor: | ||
Lung function | • | • |
Asthma control | • | • |
Medication adherence | • | • |
Inhaler technique | • | • |
Education on the disease and self-management | • | |
Identification and education of individual asthma trigger factors | • | |
Monitor and detect issues on the disease management, including pharmacological and others | • |
Methods
Model overview
Model structure
Parameter input
Transition probabilities
Parameter | Value | Range | Distribution | |
---|---|---|---|---|
Low | High | |||
Monthly transition probabilities between states A–D under RMTAC + UC | ||||
A → B | 0.122 | 0.03365 | 0.35673 | Dirichlet |
A → C | 0.152 | 0.04763 | 0.39112 | Dirichlet |
A → D | 0.030 | 0.00304 | 0.23896 | Dirichlet |
B → A | 0.382 | 0.18072 | 0.63454 | Dirichlet |
B → C | 0.032 | 0.00306 | 0.26248 | Dirichlet |
B → D | 0.058 | 0.00895 | 0.29784 | Dirichlet |
C → A | 0.184 | 0.08224 | 0.36201 | Dirichlet |
C → B | 0.008 | 0.00042 | 0.13430 | Dirichlet |
C → D | 0.043 | 0.00867 | 0.18760 | Dirichlet |
D → A | 0.088 | 0.01812 | 0.33530 | Dirichlet |
D → B | 0.051 | 0.00708 | 0.28827 | Dirichlet |
D → C | 0.088 | 0.01812 | 0.33530 | Dirichlet |
Effectiveness factor | ||||
Asthma control | OR 3.059 | 1.632 | 5.733 | Log normal |
Medication adherence | OR 1.89 | 1.08 | 3.30 | Log normal |
Monthly probabilities of low adherence level patient to have an exacerbation | ||||
B → E | 0.09273 | 0.07489 | 0.11021 | Beta |
B → F | 0.00412 | 0.00330 | 0.00495 | Beta |
D → E | 0.23237 | 0.19068 | 0.27191 | Beta |
D → F | 0.05390 | 0.04335 | 0.06432 | Beta |
Risks of high adherence level patient to have an exacerbation | ||||
A → E | HR 0.72 | 0.34 | 1.51 | Log normal |
A → F | HR 0.72 | 0.34 | 1.51 | Log normal |
C → E | HR 0.59 | 0.37 | 0.95 | Log normal |
C → F | HR 0.59 | 0.37 | 0.95 | Log normal |
Monthly probabilities of having good/poor asthma control after an exacerbation | ||||
E → A | 0.02528 | 0.01962 | 0.03132 | Beta |
E → C | 0.10484 | 0.07127 | 0.16332 | Beta |
F → A | 0.02394 | 0.01862 | 0.02961 | Beta |
F → C | 0.10738 | 0.07261 | 0.16990 | Beta |
Monthly probabilities of having an exacerbation after a recent exacerbation | ||||
E → F | 0.047 | 0.0376 | 0.0564 | Beta |
F → E | 0.047 | 0.0376 | 0.0564 | Beta |
Monthly probability of mortality after an exacerbation that does not involve hospitalization | ||||
E → G | 0.000059 | 0.000048 | 0.000071 | Beta |
Utilities input for base case analysis | ||||
A | 0.5583 | 0.4435 | 0.6731 | Beta |
B | 0.5583 | 0.4435 | 0.6731 | Beta |
C | 0.5316 | 0.3788 | 0.6844 | Beta |
D | 0.5316 | 0.3788 | 0.6844 | Beta |
E | 0.5311 | 0.4254 | 0.6368 | Beta |
F | 0.3842 | 0.2882 | 0.4802 | Beta |
Utilities input for PSA | ||||
A | 0.5598 | 0.4588 | 0.6608 | Beta |
B | 0.5598 | 0.4588 | 0.6608 | Beta |
C | 0.5316 | 0.3788 | 0.6844 | Beta |
D | 0.5316 | 0.3788 | 0.6844 | Beta |
E | 0.4514 | 0.3589 | 0.5439 | Beta |
F | 0.2919 | 0.2091 | 0.3747 | Beta |
Monthly direct cost ($)* | ||||
A (maintenance) | 38.78 | 33.77 | 43.78 | Gamma |
B (maintenance) | 39.70 | 34.70 | 44.71 | Gamma |
C (maintenance) | 42.48 | 37.46 | 47.50 | Gamma |
D (maintenance) | 38.67 | 35.62 | 45.64 | Gamma |
E (ED management) | 13.50 | 12.53 | 14.46 | Log normal |
F (hospitalization) | 552.13 | 468.03 | 636.23 | Gamma |
RMTAC recruitment (cycle 0) | 12.38 | 9.30 | 15.48 | Gamma |
RMTAC 3 monthly follow-up (cycle 1–15) | 2.23 | 1.91 | 2.54 | Gamma |
RMTAC biannual follow-up (cycle 16 and above) | 1.11 | 0.96 | 1.27 | Gamma |
Utilities
Costs
Validation
Sensitivity analysis
Results
Base-case analysis
Outcome | RMTAC + UC | UC |
---|---|---|
Life years | 27.88 (27.73–28.00) | 27.76 (27.58–27.93) |
QALYs | 9.61 (7.97–11.29) | 9.43 (7.85–11.00) |
Number of hospitalization | 16.60 (10.73–23.99) | 22.22 (14.20–31.40) |
Costs ($)* | 16,370.35 (13,410.62–20,220.91) | 18,780.21 (14,822.97–23,577.53) |
ICER (vs. UC) | ||
$ per QALY gained | − 13,639.40 (− 109,556.90 to 104,445.54) | |
$ per hospitalization averted | − 428.93 (− 521.27 to (− 328.69)) |