Cost and efficiency of a community-based asthma case management intervention program

Objective: The Institute of Medicine states that in an efficient health care system, resources are used to get the best value for the money spent. The Community Asthma Initiative (CAI) was developed to provide an effective and efficient individualized case management program for children with asthma, residing in high prevalence areas, to reduce their Emergency Department (ED) visits and hospitalizations.

Methods: The hospital costs associated with asthma emergency room visits and inpatient stays for patients enrolled in the CAI program were obtained for one year prior to their enrollment in the program (baseline) and one year forward from the entry into the program. These costs were summed to provide the total baseline and intervention period values.

Results: Between October 2005 and December 2006,120 patients were enrolled in the program. The total hospital costs of ED visits and hospitalizations for these patients were $331,531 during the one year period prior to their enrollment and $184,848 one year post enrollment. This represents a cost reduction of 44%. One year prior to enrollment, the median (95% CI) cost of care per enrolled patient was $1136 ($696, $2330) and one year post-enrollment was $225 ($0, $644). These calculations do not yet include program cost, physician cost and lost work time.

Conclusion: There has been a major cost reduction between baseline and one year post-enrollment. This reduction may be a financial incentive to third party payors to support programs like the CAI.