Is asthma self-management cost-effective?

Many clinical studies have shown that self-management and educational programs in asthma are effective. However, these programs are costly themselves and could also lead to higher drug costs due to higher rates of compliance. On the other hand, if better usage of available treatment leads to better asthma control, the patients' utilization of other health care resources and absence from work might be reduced. An interesting question is therefore whether the self-management and educational programs in asthma have been cost-effective. This study holds a review of the evidence of cost-effectiveness of self-management and educational programs in asthma. Several methodological flaws were detected (for example, a common effectiveness variable is lacking in the literature) and suggestions of improvements were given. The overall picture is, however, that self-management and educational programs in asthma are cost-effective interventions, both for children and for adults. As would be expected, it also seems as if programs directed at high risk groups and patients with severe asthma are even more cost-effective. Costs for absence from work were often excluded, which could lead to further societal savings. Also, some studies showed that the effect of the self-management and educational programs had effects even after the initial year. Since most studies only covered the initial year of treatment, the cost-effectiveness of self-management and educational programs in asthma is likely to be underestimated in the reported studies. (C) 1997 Elsevier Science Ireland Ltd.