Valuing impact: Estimating return on investment of mental health and wellbeing projects for veterans and first responders.

Asthma is one of the most prevalent chronic diseases worldwide, affecting an estimated 1–29% of the global population and causing significant morbidity and mortality [, ]. With recent therapeutic advances, particularly the advent of biologic therapies, the concept of asthma remission has emerged as a meaningful and achievable goal in both research and in clinical practice. A number of definitions for asthma remission exist, typically defined by the absence of symptoms, exacerbations and oral corticosteroid use, with or without normalisation of lung function and inflammatory markers []. Current asthma remission criteria were established based on consensus discussions with stakeholders with limited patient input and thus may not capture the complex impact that asthma has on a patient's daily living and what remission means to a patient. For example, in rheumatoid arthritis (RA), patients value the absence of pain, sleep and emotional wellbeing, whereas physicians prioritise joint counts and inflammatory markers []. This results in discordance in the assessment of remission, with studies showing only moderate agreement between patient experiences and assessments by healthcare providers (kappa statistics of 0.2–0.5) [–]. Patient perspectives in asthma remission are paramount. Asthma can be highly variable, be elusive on objective testing and relies on patient self-management that is central to the success of asthma management outcomes. Furthermore, a clinician's assessment may fail to capture remission in a patient with airway remodelling that leads to persistent airflow limitation with minimal impact on daily living. As such, an expert consensus framework for asthma remission highlighted the critical need for patient and health care provider agreement []. To date there is no understanding of how the patient's perspective can be incorporated and assessed consistently and systematically [, ]. “Remission” itself is not a novel term and has been used for decades for other chronic diseases such as autoimmune conditions and malignancy. Within these fields the patient's experience of remission has been more thoroughly assessed but this has not been done for asthma. We identified and mapped the existing literature pertaining to patient reported outcome measures (PROMs) for remission in other chronic disease with the aim of using these findings to inform the development of a PROM for asthma remission.