Primary asthma prevention amongst children — A cost-effectiveness analysis in a decision-analytic framework

Background: Primary (prenatally-started) asthma prevention may be unifaceted or multifaceted when one or more allergen-avoidance measures are used, respectively. Presently, no study has directly compared these two categories of prevention to usual care (UC) in a trial or economic evaluation. Aim: To model the cost-effectiveness of prenatally-started unifaceted (UF) and multifaceted asthma (MF) primary prevention programmes with UC in a decision-analytic framework. Methods: A decision-tree model was developed to compare (from a healthcare perspective) two UFs and three MFs programmes to UC (unstructured allergen-avoidance advice in the Netherlands). Analyses had a time horizon of 10 years. Costs and effects for each option were evaluated through incremental cost-effectiveness ratios (ICERs). Results: UC and an MF were found to dominate the other options. UC turned out to be less effective but also less costly compared to the MF. To avoid one asthma case the costs will be €8,250 when choosing the MF over UC. Most of the uncertainty in the results was attributable to the cost estimates for low-risk children. Conclusion: Although there is no point of reference for the amount society would be willing to pay to avoid a case of asthma, the threshold used for a QALY roughly ranges between € 20,000 and € 80,000. As a case of asthma prevented will certainly equal at least one QALY gained, this study gives support to the feasibility of multifaceted programmes as viable option to replace usual care in the primary prevention of asthma amongst children.