Clinical outcomes and micro-costing of bronchial thermoplasty in severe asthma in the UK

Abstract

Bronchial thermoplasty (BT) is a cost-effective (Zafari Z et al. PLoS One. 2016, 11:1) therapy for severe asthma (SA) delivered in three bronchoscopic procedures. National Institute for Health and Care Excellence recently recognized the safety and efficacy of BT for SA treatment (NICE IPG635,2018). Aim: Measure patient outcomes pre and post BT treatment and compare the actual cost of BT to national reference costs and tariff income to assess the adequacy of current payment in the UK. Methods: We performed a retrospective micro costing study on 53 BT procedures (total of 18 patients) over the 2012-2017 period at a UK hospital. We collected patient outcomes 12 months before and after BT. For comparison we used 2017/18 national reference costs and national tariffs of the HRG DZ67Z Major Therapeutic Bronchoscopy. Results: After BT, we observed a significant improvement in mean FEV1(1.99L ± 0.64 vs 2.50L ± 0.66; p=0.001), and a reduction of mean rescue oral corticosteroid/year (6.6 ± 4.2 vs 1.5 ± 1.7; p=0.00004). The average cost of a BT session was £3362 for day cases (DC) performed under sedation (n=22), £4354 for elective admissions (EL) under sedation (n=27), £6925 for EL under general anesthesia (n=4). This compares to 2017/18 reference costs for DC and EL of £1380 and £2563 respectively, demonstrating an average deficit of £2064. 2017/18 tariff for DC and EL of £2050 does not cover BT admission costs whether BT is done as a DC or EL. Conclusions: In this patient group BT improved health outcomes. Micro costing reveals that reference costs do not reflect the actual cost of BT. Since reimbursement is based on reference costs, BT is underfunded, which may represent a barrier to patient access.