Within Dutch health care, Zorginstituut Nederland regularly selects topics for reassessment of diagnostic and therapeutic interventions. Until now, about 15 topics have been investigated, such as hip/knee arthrosis, stable angina, low back pain, urinary incontinence, palliative care, retinopathy and asthma.

For each topic, stakeholders were asked to report what could be improved. Also a working group was created to analyze: what do guidelines recommend, what does actual care look like seen from administrative data, is there a gap between guidelines and delivered care, what can be improved? A report with recommendations was written with a calculation of the impact. Agreements were made on implementation. This report focused on findings relating to asthma.

We identified the multiple issues in the management of asthma: (i) Only 11 percent of patients had their diagnosis confirmed (with spirometry and reversibility or visit to pulmonologist). (ii) 60,000 patients had intensive short acting broncho-adrenegic agents (SABA) without inhaled corticosteroids (ICS) representing overuse of SABA. (iii) 200,000 patients use inhalers that can be empty, without the patient knowing this, as there is no indicator showing the number of actuation/puffs left, which leads to under treatment. (iv) 60.000 patients have aerosol and powder inhalers together, each requiring a different technique, leading to mistakes. (v) 67 percent of asthma adults get a chest x-ray on referral to hospital, which is a high proportion. (vi) 49 percent of patients use inhalers with propellant, which is needlessly high, given their undesirable impact on climate change. This causes 36 million kg co2 equivalent, the same as 36000 extra gasoline cars. (vii) Only 37 percent of patients receive yearly monitoring. We calculated that EUR 14 million annually can be saved as a result of better diagnosis leading to less overdiagnosis and overtreatment and less spacers.

Despite that ‘HTA (Health Technology Assessment) at the doorstep’ has been applied for asthma interventions, we noticed considerable room for improvement. We consider this method important for real HTA life cycle approach.