Cost Of Asthma Care Research Articles

Leveraging Telemedicine to Reduce the Financial Burden of Asthma Care

One of the most compelling arguments for telemedicine is its potential to increase health care access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the United States, where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal health outcomes. In this clinical commentary review, we draw from the literature and our own research to identify opportunities for and challenges to leveraging telemedicine to reduce the financial burden of asthma care. Our interviews with 42 families affected by asthma during the COVID-19 pandemic suggest that under favorable circumstances, telemedicine can meaningfully reduce costs, including those related to transportation and missed work, while offering high-quality care. However, families also identified ways in which telemedicine can increase costs. For example, some reported reduced access to support services and material resources such as medication samples, which they relied on to manage costs. In this way, our findings underscore the need for careful care coordination and communication in telemedicine. We conclude by discussing the 4Rs, a structured communication approach designed to support cost conversations, increase care coordination, and help families reduce asthma care cost burden.

Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study

Objective Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. Methods We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies’ implications for adherence. Results Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. Conclusion Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.

Efecto y seguridad de un tratamiento ambulatorio de medicina tradicional para el asma en 26 pacientes de Cota, Colombia: una serie de casos

The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could be explored with experimental studies to determine their long-term effectiveness, safety and low cost.

Year in review 2017: Chronic obstructive pulmonary disease and asthma.

Year in review 2017: Chronic obstructive pulmonary disease and asthma.

Modification of an Established Pediatric Asthma Pathway Improves Evidence-Based, Efficient Care.

In September 2011, an established pediatric asthma pathway at a tertiary care children's hospital underwent significant revision. Modifications included simplification of the visual layout, addition of evidence-based recommendations regarding medication use, and implementation of standardized admission criteria. The objective of this study was to determine the impact of the modified asthma pathway on pathway adherence, percentage of patients receiving evidence-based care, length of stay, and cost. Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were analyzed for 24 months before and after pathway modification. Statistical process control was used to examine changes in processes of care, and interrupted time series was used to examine outcome measures, including length of stay and cost in the premodification and postmodification periods. A total of 5584 patients were included (2928 premodification; 2656 postmodification). Pathway adherence was high (79%-88%) throughout the study period. The percentage of patients receiving evidence-based care improved after pathway modification, and the results were sustained for 2 years. There was also improved efficiency, with a 30-minute (10%) decrease in emergency department length of stay for patients admitted with asthma (P = .006). There was a nominal (<10%) increase in costs of asthma care for patients in the emergency department (P = .04) and no change for those admitted to the hospital. Modification of an existing pediatric asthma pathway led to sustained improvement in provision of evidence-based care and patient flow without adversely affecting costs. Our results suggest that continuous re-evaluation of established clinical pathways can lead to changes in provider practices and improvements in patient care.

Asthma in children

Asthma affects 1 100 000 children in the UK and is thus the most common long-term condition of childhood. The prevalence of childhood asthma symptoms in the UK is among the highest worldwide and this contributes to the estimated £1 billion annual cost of asthma care to the NHS. Children still die from asthma despite advances in its management, and mortality rates have changed very little over the past 20 years. The recent national review of asthma deaths provided a stark reminder of ‘why asthma still kills’ and made key recommendations for children with asthma. However, evidence-based recommendations are still poorly implemented. This article seeks to enthuse the next generation of GPs to prioritise the improvement of asthma care in children.

Direct medical cost of Thai pediatric asthma management: a pilot study.

The prevalence of asthma in Bangkok increased steadily over the last couple of decades and warrants an assessment of the costs associated with its treatment, particularly in the case of children. To estimate the direct medical costs of asthma care in children at the Allergy unit of the Department of Pediatrics, Ramathibodi hospital. In this retrospective study, we included asthmatic children aged less than 20 year-old having visited the allergy unit at least 4 times in 12 months between January and December, 2011. Cost data, retrieved from the allergy unit electronic database included billing invoices of inpatient care, outpatient and emergency room visits. From this dataset we estimated drug costs, physician and nursing services, diagnostic tests and procedures, supplies and room charges, and assessed an overall asthma-related direct medical cost. Ninety-seven asthmatic children (aged 11.5 ± 3.7 years) were included in the study. Annual median direct medical cost was 8,537.9 Baht or 278 USD per patient. Annual direct medical cost was the highest in patients younger than 5 years old (p < 0.001). Moreover, expenses of patients who had at least one exacerbation increased significantly compared to patients without exacerbation (p = 0.02). Furthermore, direct medical cost was the highest when patients had exacerbation requiring hospitalization (p = 0.03). Cases of patients having asthma exacerbation or being diagnosed with asthma before 5 years of age were associated with higher treatment expenses. Policies developed to achieve asthma control and prevention should identify young children and patients presenting risk factors for asthma exacerbation as high risk groups deserving particular attention.

Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country

Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51%) were females. Also, 72 (65%) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US$368.4 (±228) per patient. Medication cost accounted for the majority (87%) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted.

Risk factors for asthma hospitalization and emergency department visit in Nigeria: The role of symptoms frequency and drug utilization

Background: Substantial proportion of the economic cost of asthma care is due to hospitalization and emergency department (ED) visit. The objective of our study was to identify the role of frequency of asthma symptoms and drug utilization as risk factors for asthma related hospitalization and ED visit among adult patients in selected hospitals in Nigeria. Patients and Methods: We carried out a cross sectional study of a sample of adult patients in selected hospitals in Nigeria. Demographic, clinical information, and use of asthma medications were obtained from the patients that were hospitalized or visited ED and those not hospitalized or visited ED in previous 12 months. Results: A total of 102 patients participated in the study. Fifty (49.0%) of the patients were hospitalized or visited the ED and 52 (51.0%) were neither hospitalized nor visited ED. Asthma patients who experienced frequent nocturnal symptoms (relative risk (RR)-3.50, 95% confidence interval ( C I) 2.05-4.96), frequent use of rescue medication (RR-2.89, 95% CI 1.66-4.12), increased daytime (RR-2.32, 95% CI 1.32-3.32), and nasal symptoms (RR-2.30, 95% CI 1.11-3.48) were more likely to be hospitalized or visited ED. Patients who used oral theophylline (RR-2.19, 95% CI 1.35-2.33) without doctor's prescription were two times more likely to be hospitalized or visited ED. The use of inhaled corticosteroids (ICS, RR-0.69, 95% CI 0.45-0.99) and oral corticosteroids (OCS; RR-0.73, 95% CI 0.00-1.59) were not associated asthma related hospitalization and ED visit. Conclusion: There is a need for pragmatic interventions in patients who reported increased asthma and nasal symptoms, increased use of rescue medication, and nonprescription use of oral theophylline in order to prevent acute asthma hospitalization and emergency visit.

Anti-inflammatory Medication Adherence and Cost and Utilization of Asthma Care in a Commercially Insured Population

Objective. The authors hypothesized that adherence to anti-inflammatory treatment could reduce overall cost of asthma care, as higher spending on drugs would be offset by reductions in hospital and emergency care. Methods. A retrospective observational study using 2 years of claims data for 41,234 commercially insured asthmatics on monotherapy with either leukotriene inhibitors (LI) or inhaled corticosteriods (ICS). Patients were grouped into adherence quartiles based on the percentage of days per year they had prescriptions filled (medication possession ratio). The relationship between adherence and four outcomes was examined: () emergency department (ED) visits, () hospitalizations, () nondrug net payments for asthma care, () total net payments for asthma care (including drug costs). Multivariate and logistic regression models adjusting for demographics, comorbidities, and measures of past asthma utilization were used. Results. Adherence rates were low with a median medication possession ratio of 39% for LI and 15% for ICS. Both ED and hospital use was negatively associated with adherence to LI. Patients in the lowest quartile experienced 80 (95% confidence interval (CI) = 62–102) ED visits and 34 (95% CI = 22–52) admissions per 1000 patient-years compared to 36 (95% CI = 27–49) ED visits and 13 (95% CI = 8–22) admissions in the highest quartile. In contrast, ED visits and hospital admissions did not differ significantly between adherence groups for ICS. Total payments for asthma care increased significantly with higher adherence for both LI and ICS patients. Comparing the lowest and highest adherence quartile, payments per person per month increased significantly from $65.11 (95% CI = $57.02–$73.20) to $147.46 (95% CI = $139.48–$155.44) for patients on LI and from $38.71 (95% CI = $29.52–$47.90) to 93.13 (95% CI = $83.70–$102.56) for patients on ICS. The only subgroup, for which overall asthma payments did not increase with better adherence, were patients with past ED visit or hospital admission on LI. Conclusions. In this observational study, treatment with LI, but not with ICS, appears to improve disease control, as evidenced by the reduction in the incidence of ED visits and hospitalizations in patients on LI. Savings generated by this reduction in high-cost events don't offset the increased payments for drugs in more adherence patients, except for selected high-risk patients.

CFC-Free Inhalers May Add $1.5B to Asthma Care Costs

CFC-Free Inhalers May Add $1.5B to Asthma Care Costs

Comparative Efficacy and Cost of Asthma Care in Children with Asthma Treated with Fluticasone Propionate and Montelukast

To assess the comparative efficacy of fluticasone propionate (FP) and montelukast (MON), using administrative claims for pediatric asthma in a clinical setting. This retrospective observational study used the PharMetrics Integrated-Outcomes Database. Children age 4 to 17 years with an ICD-9-CM 493.xx for asthma, therapy with an inhaled corticosteroid in the 12 months before the index medications, and an index claim for FP or MON between January 2001 and December 2003 were studied. FP- and MON-treated children were propensity-matched based on health care utilization. Asthma-related parameters studied included treatment failure, hospitalizations, and total cost of care. The children treated with MON were more likely to experience treatment failure (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 2.19 to 2.96) and to be admitted to the hospital for asthma-related care (OR = 1.99; 95% CI = 1.15 to 3.44) compared with those treated with FP. Furthermore, the children treated with MON incurred significantly higher asthma-related treatment costs compared with those treated with FP (parameter estimate = 0.418; P < .0001). In children with asthma, treatment with FP is associated with better outcomes and lower cost than treatment with MON.

Asthma control and its direct healthcare costs: findings using a derived Asthma Control TestTMscore in eight Asia-Pacific areas

The present authors explored the relationship between asthma control status, measured using a derived Asthma Control TestTM(ACT) score, and utilisation of healthcare and its cost in eight Asia-Pacific areas.Patients were included if they were aged ≥12 yrs and had participated in a recent survey of asthma patients. Patient-reported frequency of healthcare resource use was used to estimate the cost of asthma care. The ACT score was derived from survey questions identical or similar to the items comprising the ACT.An ACT score was derived for 2,062 patients, of whom 59% (1,220) scored &lt;20, suggesting that their asthma was not well controlled, and with 21% (423) scoring &lt;15, suggesting poorly controlled asthma. The mean per-patient annual cost of asthma management for patients with a derived ACT of &lt;15 was US$861 (95% confidence interval: US$686–1,042); US$319 (US$286–357) for patients with a derived ACT score of 15–19, and US$193 (US$173–214) for patients with a derived ACT score of ≥20. A higher derived ACT score was associated with significantly lower annual expenditure on asthma management.Poorer asthma control was associated with an increased frequency of all unscheduled healthcare and elevated cost. This finding was consistent across a range of Asia-Pacific areas.

Inhaled Corticosteroids versus Leukotriene Receptor Antagonists as First-line Therapy for Mild Persistent Asthma in Children?

Pediatric Asthma, Allergy & ImmunologyVol. 18, No. 4 Pharmacotherapy UpdateInhaled Corticosteroids versus Leukotriene Receptor Antagonists as First-line Therapy for Mild Persistent Asthma in Children?Prof. H. William KellyProf. H. William KellySearch for more papers by this authorPublished Online:5 Dec 2005https://doi.org/10.1089/pai.2005.18.259AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byComparative Efficacy and Cost of Asthma Care in Children with Asthma Treated with Fluticasone Propionate and MontelukastThe Journal of Pediatrics, Vol. 150, No. 2 Volume 18Issue 4Dec 2005 InformationCopyright 2005, Mary Ann Liebert, Inc.To cite this article:Prof. H. William Kelly.Inhaled Corticosteroids versus Leukotriene Receptor Antagonists as First-line Therapy for Mild Persistent Asthma in Children?.Pediatric Asthma, Allergy & Immunology.Dec 2005.259-263.http://doi.org/10.1089/pai.2005.18.259Published in Volume: 18 Issue 4: December 5, 2005PDF download

Reduced cost of managing exacerbations with stable dose treatment with salmeterol/fluticasone (SFC) compared with adjustable maintenance dosing (AMD) with formoterol/budesonide (FBC)

The high cost of asthma care is largely attributed to poor control of disease, in particular the treatment of exacerbations. A 1-year, randomised, double blind, double dummy study in adult asthmatics currently receiving >500–1000mcg ICS or 200–500mcg ICS+LABA daily. Both AMD and stable dose regimes were followed in accordance with registered indications. Cost savings from a reduction in exacerbation rates was estimated by applying UK healthcare costs to each of the exacerbation events. The ITT population comprised 688 patients (344 in each treatment arm). Thirty-nine (11.3%) patients who received stable dosing SFC experienced an asthma exacerbation compared with 61 (17.7%) patients who received AMD of FBC. Overall there were 48% fewer exacerbations with stable dosing treatment with SFC than AMD with FBC (50 vs. 96 exacerbations respectively). A significant difference between stable dosing treatment with SFC and AMD with FBC in the rate of exacerbations (wks 1–52) requiring oral steroid use or ER/hospital visit, annual adjusted mean rate SFC: 0.18 versus FBC 0.33, p= 0.008. The total annual healthcare costs of managing exacerbations for the SFC group was 荤 3770.73 (荤 5553.36) compared with 荤 6717.25 (荤 9892.86) for the AMD with FBC group. Difference in annual costs of managing exacerbations was 荤 2946.52 (荤 4339.50). This analysis showed that stable dose treatment with SFC halves the exacerbation rate and reduces the cost of managing exacerbations by 44% compared with the AMD with FBC group.

Asthma-Related Costs Relative to Severity and Control in General Practice

Limited data are available about costs of asthma care by general practitioners (GPs) in France. This study evaluated asthma care costs of children treated by GPs, and the relationship between cost and asthma control across different degrees of asthma severity. We conducted a retrospective longitudinal observational study based on a computerized prescription database of GPs supplemented with a cross-sectional survey of children aged 6–16 with persistent asthma (GINA step ≥2). Retrospective data on asthma-related medical resource utilization (MRU) were collected for a 12-month study period. MRU included antiasthma medications, visits to GPs, visits to emergency rooms, and hospitalizations. Asthma control was evaluated from recent asthma symptoms, whereas severity was defined by the average dose of inhaled corticosteroids prescribed during a preindex period. Univariate and multivariate analyses were used to evaluate relationships between MRU and other variables of interest. Among 261 children with completed surveys, the proportion of total MRU cost due to GP visits, medications, and emergency room visits was 20%, 30%, and 2%, respectively. Although hospitalizations accounted for almost 50% of total costs, only 17 children (6.5%) were hospitalized during the study period. In children with severe asthma, total MRU cost was significantly higher when control of asthma was poor, compared with moderate and good levels of asthma control (p = 0.004). However, no similar association emerged in children with low and moderate severity. A minority of children with high-cost medical use accounted for a significant part of total expenditures. Total MRU costs varied according to level of control in children with high disease severity. (Pediatr Asthma Allergy Immunol 2005; 18[1]:36–45.)

Should patients with persistent severe asthma be monitored for medication adherence?

Poor asthma outcomes often result from patients not following physician medication recommendations (ie, nonadherence). Estimates suggest that 50% of patients with asthma do not follow physician medication recommendations. To examine the rationale for making available objective medication adherence monitors for physicians to improve the quality of care for patients with severe persistent asthma. Review of the literature was undertaken in the following areas related to asthma: cost, morbidity, adherence, adherence monitoring, outcomes, and guidelines. Patients with severe asthma are at risk for nonadherence because of (1) the use of multiple medications to control symptoms, (2) coexisting disease states, (3) the occurrence of depression and anxiety, and (4) the high cost of care. Research studies have demonstrated the effectiveness of objective monitoring as part of multiple clinical strategies to improve adherence and reduce morbidity and the cost of asthma care. Without objective adherence monitoring, physicians may not accurately assess nonadherence as the cause of treatment failure. This may lead to inappropriate increases in therapy, diagnostic studies, and consultations and may leave the patient at risk for persistent symptoms, morbidity, and death. By correctly assessing nonadherence as the cause of treatment failure in patients with not only severe asthma but mild and moderate disease as well, practicing physicians may improve the quality of care provided.

The financial impact of an acute asthma emergency department visit on low-income families in Los Angeles

Rationale Many studies have addressed the societal costs of asthma care, but few have assessed costs from the patient's perspective, though cost to patient may influence use of health services. We evaluated the costs experienced by families seeking ED care for their children's asthma. Methods Costs and income data were available for 195 of 234 children in a longitudinal study of low-income families using the ED for acute asthma care. We analyzed families' costs over the course of the month following the visit. Results Descriptive analyses showed that families spent a median 6% of monthly household income on acute asthma care, and 27% of per capita monthly income. Insured families spent 19% per capita, while uninsured families spent 43% per capita. Bivariate analyses showed that overall costs were higher for those patients that were uninsured or were hospitalized after the index visit. Amount spent on transportation and child care costs did not differ significantly between insured and uninsured families at 78% of total costs. Child care was a major component of cost for hospitalized families. 28% of families report no expenses related to asthma care. Conclusions The expenses patients incur for acute asthma care impose a substantial burden on low-income families, especially those who are uninsured. Medical insurance appears to adequately indemnify most medical, but not secondary, expenses. Since expenses tend to be large in proportion to income, it appears likely that families' visits to the ED are driven by perceived medical need.

Assessing the economic burden of asthma

Assessing the economic burden of asthma

Is it cost-effective to prompt Australian parents to bring their children with asthma to the general practitioner for proactive review under the asthma 3+ visit plan?

The aim of this project was to perform an economic evaluation of the implementation of the Asthma 3+ visit Plan in Australia, in parallel with a randomised controlled trial. The trial involved 24 GPs and 174 children aged 5-11 years with moderate to severe asthma, cluster-randomised into two groups by medical practice. The control group received usual asthma care, while the intervention group were reminded to attend by the researchers prompting practices to recall patients according to the recommended schedule.The evaluation focused on the marginal costs of promoting the Asthma 3+ Visit Plan to GPs and patients, and compared the costs with the economic consequences of the plan on attendance rates, use of other health services and use of medication. Analysis was done of the difference in costs of asthma care between the two groups over a twelve-month period. A societal perspective was taken, with both direct and indirect costs being considered as they impacted on general practitioners, other health providers, patients and their families.While there was a statistically significant increase in the number of asthma-related GP visits by those in the intervention group, there was no statistically significant difference in the total number of visits, nor in the associated travel and time costs for parents of the children. The number and cost of referrals to specialists and allied health professionals were lower for the intervention group, while the use and cost of diagnostic tests was higher, but neither were statistically significant. The proportion of patients incurring any medication costs was lower in the intervention group, with a reduced cost per patient. The costs to implement the plan averaged approximately $400 per GP, with the prompts to practices costing $100 per GP. This study suggests that the 3+ plan is cost-effective when implemented with children with asthma.