Asthma control cost-utility randomized trial evaluation (ACCURATE): the goals of asthma treatment

1. sufficiently controlled asthma2. strictly controlled asthma3. strictly controlled asthma based on exhaled nitric oxide as an additional disease marker720 Patients with mild to moderate persistent asthma from general practices with a practice nurse, age 18-50 yr, daily treatment with inhaled corticosteroids (more then 3 months usage of inhaled corticosteroids in the previous year), will be identified via patient registries of general practices in the Leiden, Nijmegen, and Amsterdam areas in The Netherlands. The design is a 12-month cluster-randomised parallel trial with 40 general practices in each of the three arms. The patients will visit the general practice at baseline, 3, 6, 9, and 12 months. At each planned and unplanned visit to the general practice treatment will be adjusted with support of an internet-based asthma monitoring system supervised by a central coordinating specialist nurse. Patient preferences and utilities will be assessed by questionnaire and interview. Data on asthma control, treatment step, adherence to treatment, utilities and costs will be obtained every 3 months and at each unplanned visit. Differences in societal costs (medication, other (health) care and productivity) will be compared to differences in the number of limited activity days and in quality adjusted life years (Dutch EQ5D, SF6D, e-TTO, VAS). This is the first study to assess patient preferences and cost-effectiveness of asthma treatment strategies driven by different target levels of asthma control.Netherlands Trial Register (NTR): NTR1756Despite the availability of effective therapies, asthma remains a source of significant morbidity and use of health care resources [1,2]. The societal costs of asthma are considerable. Asthma negatively affects work productivity as well as labour force participation. Furthermore, a survey showed that in the Netherlands 30% of asthmatics needed urgent care in the past year, which was on average 8% more than in other European countries [3].