Asthma Management Programs: Results of 3 Recent Studies

Asthma is a prevalent disease that continues to be associated with significant health care costs. Kamble and Bharmal,¹ for example, estimated that the annual direct medical expenditure attributable to the treatment of asthma in the United States was about $37.2 billion in 2007, which represents a significant proportion of health care resource use.

In their study, the estimated prevalence of asthma was 8.7% in children and 6.72% in adults. The annual adjusted mean incremental total expenditure associated with asthma was $1004.6 per child and $2077.5 per adult. Physician office visits and prescription drugs accounted for 49% and 38%, respectively, of the total incremental expenditures.

A variety of asthma management programs have been developed to improve asthma control and reduce asthma-related costs. Several recent reports are worth noting.

A Pediatric Asthma Management Program Reduces Overall Costs of Care
An asthma management program for children in an urban community has been shown to reduce overall costs of care. Cloutier and associates² evaluated the costs of participating in a pediatric asthma management program in Hartford, Conn. The study included 3298 children who were enrolled in the Easy Breathing program, a program designed to decrease the use of asthma-related health care services. They assessed the costs of participating in this program for the first 3 years relative to the costs of not participating, by applying Medicaid reimbursement rates to data on services.

The start-up costs for participating in the program in the first year were $28.95 per child. The average operating costs were $10.28 per child for years 2 and 3. The mean reduction in costs associated with the program was $36.72 per child in years 2 and 3. If Medicaid managed care plans had been charged an amount equal to the program operating costs after year 1, the at-risk health plans could have incurred cost savings of about $26.44 per child with asthma per year. The potential return on investment for years 2 and 3 was $3.58 per US dollar spent.

In-Home Asthma Management Program Provided By Respiratory Therapists
Shelledy and colleagues³ report that an in-home asthma management program provided by respiratory therapists (RTs) can help reduce asthma-related hospitalizations and costs and improve health-related quality of life. Their study included 159 adults who had been admitted to an emergency department or hospital for treatment of an acute exacerbation of asthma. The patients were randomly assigned to an asthma management program run by an RT, to an asthma management program run by an RN, or to usual care provided in a physician’s office or clinic. Those in the asthma management programs received 5 weekly home visits to provide asthma assessment and instruction.

After 6 months, the RT and RN home-management groups had fewer hospitalizations and in-patient days, lower hospitalization costs, and more improvement in health-related quality of life and patient satisfaction, compared with the group that received usual care. Peak expiratory flow rate and symptom improvement were higher in the RT-run group than in the usual care group. Asthma episode self-management scores and patient satisfaction were higher in the RT-run group than in the RN-run group or the usual care group.

Individualized Self-Management Improves Adherence to Treatment
In a study conducted by Janson and co-workers,⁴ 84 adults with moderate-to-severe asthma were randomly assigned to an intervention that involved individualized self-management education that included self-monitoring of symptoms and peak expiratory flow or to usual care with self-monitoring alone. The intervention specifically involved asthma information, assessment, and correction of inhaler technique; an individualized action plan based on self-monitoring results; and environmental control strategies for avoiding allergen and irritant exposures. The intervention was personalized on the basis of the patient’s pulmonary function test results, allergen skin test reactivity, and inhaler technique. It was 30 minutes in duration and was reinforced at 2-week intervals.

The investigators found that adherence to inhaled corticosteroid therapy was significantly better in the self-management group than in the usual care group. In fact, at the end of the intervention, those in the intervention group were 9 times more likely to have an adherence level greater than 60%. The intervention also was associated with greater improvement in the perception of asthma control, fewer nighttime awakenings, and less use of inhaled -agonists.
  
References
1. Kamble S, Bharmal M. Incremental direct expenditure of treating asthma in the United States. J Asthma. 2009;46:73-80.
2. Cloutier MM, Grosse SD, Wakefield DB, et al. The economic impact of an urban asthma management program. Am J Manag Care. 2009;15:345-351.
3. Shelledy DC, Legrand TS, Gardner DD, Peters JI. A randomized, controlled study to evaluate the role of an in-home asthma disease management program provided by respiratory therapists in improving outcomes and reducing the cost of care. J Asthma. 2009;46:194-201.
4. Janson SL, McGrath KW, Covington JK, et al. Individualized asthma self-management improves medication adherence and markers of asthma control. J Allergy Clin Immunol. 2009;123:840-846.