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Boston children's hospital community asthma initiative: Five-year cost analyses of a home visiting program
Urmi Bhaumik1,2, Susan J Sommer1, Judith Giller-Leinwohl1
1a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA.
Insights
The Community Asthma Initiative (CAI) demonstrated significant cost savings, reducing emergency department visits and hospitalizations. This asthma management program yielded a 1.91 adjusted return on investment over five years.
Area of Science:
- Public Health
- Health Services Research
- Healthcare Economics
Background:
- Asthma management programs are crucial for reducing healthcare costs associated with emergency department (ED) visits and hospitalizations.
- The Boston Children's Hospital Community Asthma Initiative (CAI) was implemented to assess the economic impact of community-based asthma care.
Purpose of the Study:
- To evaluate the cost-effectiveness of the CAI by analyzing reductions in ED visits and hospitalizations.
- To determine the adjusted Return on Investment (ROI) for participants in the CAI pilot program.
Main Methods:
- A cost-benefit analysis was performed using hospital administrative data for 268 CAI participants.
- A comparison group of 818 patients from similar ZIP codes without CAI intervention was used.
- Cost data from October 2005 to June 2013 were analyzed to calculate ROI over a 5-year post-intervention period.
Main Results:
- CAI patients experienced greater cost reductions than the comparison group, ranging from $997 to $1,320 annually over five years.
- The intervention resulted in significant cost savings, with a P-value < 0.001 in the first two years.
- An adjusted ROI of 1.91 was calculated over the 5-year post-intervention period.
Conclusions:
- Community-based, multidisciplinary asthma management programs effectively decrease costly hospitalizations and ED visits.
- The positive ROI supports the integration of community-based asthma services into patient-centered medical homes and Accountable Care Organizations.
- This study provides a strong business case for investing in comprehensive community asthma care.
Objective:
To evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) through reduction of Emergency Department (ED) visits and hospitalizations for the full pilot-phase program participants.
Methods:
A cost-benefit analyses was conducted using hospital administrative data to determine an adjusted Return on Investment (ROI): on all 268 patients enrolled in the CAI program during the 33-month pilot program phase of CAI intervention between October 1, 2005 and June 30, 2008 using a comparison group of 818 patients from a similar cohort in neighboring ZIP codes without CAI intervention. Cost data through June 30, 2013 were used to examine cost changes and calculate an adjusted ROI over a 5-year post-intervention period.
Results:
CAI patients had a cost reduction greater than the comparison group of $1,216 in Year 1 (P = 0.001), $1,320 in Year 2 (P < 0.001), $1,132 (P = 0.002) in Year 3, $1,123 (P = 0.004) in Year 4, and $997 (P = 0.022) in Year 5. Adjusting for the cost savings for the comparison group, the cost savings from the intervention resulted in an adjusted ROI of 1.91 over 5 years.
Conclusions:
Community-based, multidisciplinary, coordinated disease management programs can decrease the incidence of costly hospitalizations and ED visits from asthma. An ROI of greater than one, as found in this cost analysis, supports the business case for the provision of community-based asthma services as part of patient-centered medical homes and Accountable Care Organizations.
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