Boston children's hospital community asthma initiative: Five-year cost analyses of a home visiting program

Abstract

Objective: To evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) through reduction of Emergency Department (ED) visits and hospitalizations for the full pilot-phase program participants. Methods: A cost-benefit analyses was conducted using hospital administrative data to determine an adjusted Return on Investment (ROI): on all 268 patients enrolled in the CAI program during the 33-month pilot program phase of CAI intervention between October 1, 2005 and June 30, 2008 using a comparison group of 818 patients from a similar cohort in neighboring ZIP codes without CAI intervention. Cost data through June 30, 2013 were used to examine cost changes and calculate an adjusted ROI over a 5-year post-intervention period. Results: CAI patients had a cost reduction greater than the comparison group of $1,216 in Year 1 (P = 0.001), $1,320 in Year 2 (P < 0.001), $1,132 (P = 0.002) in Year 3, $1,123 (P = 0.004) in Year 4, and $997 (P = 0.022) in Year 5. Adjusting for the cost savings for the comparison group, the cost savings from the intervention resulted in an adjusted ROI of 1.91 over 5 years. Conclusions: Community-based, multidisciplinary, coordinated disease management programs can decrease the incidence of costly hospitalizations and ED visits from asthma. An ROI of greater than one, as found in this cost analysis, supports the business case for the provision of community-based asthma services as part of patient-centered medical homes and Accountable Care Organizations.

Keywords:

• Asthma; community intervention; cost; ROI

Declaration of interest

The authors report no conflicts of interest.

Funding

This study was supported in part by Centers for Disease Control and Prevention REACH US Cooperative Agreement grant 1U58DP001055 (design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of manuscript); Healthy Tomorrows Partnership for Children Program H17MC06705 from Maternal and Child Health (MCH) Bureau, Health Resources and Services Administration (design of the study; interpretation of the data); Health Resources in Action's CMS Innovation Award #1C1CMS331039 (management, analysis, and interpretation of the data); Leadership Education in Adolescent Health training grant #T71MC00009 (MCH Bureau), Health Resources and Services Administration (design of the study; interpretation of the data; and preparation of the manuscript); and the Ludke, Covidien, Boston Scientific, BJ and Thoracic Foundations (conduct of the study; collection, management, and analysis of the data), and the Boston Children's Hospital Program for Patient Safety and Quality (PPSQ) and Office of Community Health (design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, and review of the manuscript).