TY - JOUR T1 - Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial JF - British Journal of General Practice JO - Br J Gen Pract SP - 119 LP - 124 VL - 55 IS - 511 AU - Hilary Pinnock AU - Lynda McKenzie AU - David Price AU - Aziz Sheikh Y1 - 2005/02/01 UR - http://bjgp.org/content/55/511/119.abstract N2 - 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.Methods 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 [SD = 73.33] versus surgery = 59.48 [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 versus surgery = 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = 7.19 [SD = 2.49] versus surgery = 11.11 [SD = 3.50]; mean difference = −3.92 [95% confidence interval = −4.84 to 3.01], 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. ER -