A Cost Analysis for a Community-Based Case Management Intervention Program for Pediatric Asthma

Abstract

Objective. Evaluate the costs and benefits of the Boston Children’s Hospital Community Asthma Initiative (CAI) program through reduction of Emergency Department (ED) visits and hospitalizations and quality of life (QOL) for patients and their families due to reduced missed school days and work days. Methods. Cost–benefit analysis was used to determine an adjusted Return on Investment (ROI) for all 102 patients enrolled in the CAI program in the calendar year 2006 after controlling for changes in a comparable population without CAI intervention. A societal ROI (SROI) was also computed by including additional indirect benefits due to reduced missed school days for patients and work days for caregivers. Results. Adjusted cost savings from fewer ED visits and hospitalizations resulted in an adjusted ROI of 1.33 (adjusted Net Present Value, (NPV) of savings = $83,863) during the first 3 years after controlling for factors other than the CAI intervention. When benefits due to reduced missed school days and missed work days were added to adjusted cost savings, the SROI increased to 1.85 (Societal NPV of savings = $215,100). Conclusions. Multidisciplinary, coordinated disease management programs offer the opportunity to prevent costly complications and hospitalizations for chronic diseases, while improving QOL for patients and families. This cost analysis supports the business case for the provision of proactive community-based asthma services that are traditionally not reimbursed by the fee-for-service health care system.

• cost savings
• net present value (NPV)
• quality of life (QOL)
• social return on investment (SROI)

Acknowledgments

We would like to thank the staff and participants of the Boston Children’s Hospital Community Asthma Initiative, Subhendu Roy, PhD, Independent Economic Consultant, Mihail Samnaliev, PhD, Health Economist, Boston Children’s Hospital, as well as Laurie Stillman, MM, from the New England Asthma Regional Council, Boston, MA, for their helpful comments. Lastly, we would like to thank Lindsay Tsopelas, BA, for her help with the preparation of the manuscript.