Cost-benefit analysis of childhood asthma management through school-based clinic programs

The CDC reported asthma prevalence in early 2000's averaging 5 million school-aged children 5-17 years. Whereas costs of childhood asthma are well studied, cost-benefits of managing asthma in school-based health clinics (SBHCs) have not been explored. SBHCs offer convenient access and less costly essential primary healthcare for students. SBHC use has been shown to lower asthma-associated ER visits and hospitalizations through closer monitoring and improving medication compliance. The purpose of this study is to determine the economic benefits of this primary care alternative to reduce the cost burden for management of childhood asthma.

In 2004, the Department of Education estimated that 12% of schools offered “health care services beyond those provided by a school nurse”. Using median school nurse salary at 2009 levels, direct medical costs of $3.438 billion due to additional nurse salary was required to implement SBHC programs nationwide. Medical Expenditure Panel Survey (2006) data were used to calculate cost-savings of SBHC's reduction in asthma-associated hospital outpatient or office-based provider visits, ER visits, hospitalizations, and prescribed medicines. The estimated direct medical savings from SBHCs was $3.324 billion, in expenditures for fewer office visits, medications, hospitalizations, and ER visits. In addition, the indirect costs of a parent's loss of earnings for every asthma-associated school absence would be reduced by an estimated $2.294 billion, given a median hourly 2006 wage level. Thus, the estimated total economic savings from SBHCs could be $5.618 billion, producing a $433 net savings per child with asthma.