Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial.

Hilary Jane Pinnock, Lynda McKenzie, David Brendan Price, A. Sheikh

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)119-124
Number of pages5
JournalThe British Journal of General Practice
Publication statusPublished - 2005


  • asthma
  • cost-effectiveness
  • primary care
  • telephone


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