Improved 10-year cost savings for patients served by the Boston Children’s Hospital Community Asthma Initiative

Abstract

Objective

To provide a 10-year follow-up of asthma cost-savings for patients served by the Community Asthma Initiative (CAI) group compared to a coarsely cost-matched comparison group from similar neighborhoods (comparison group).

Methods

CAI provided home visits and case management services for patients identified through emergency department (ED) visits and hospitalizations. Asthma costs for the two groups were extracted from the hospital administrative database for ED visits and hospitalizations for one year before and 10 years of follow-up. To eliminate cost differences at intake, a coarse cost-matching was implemented by randomly selecting comparison patients with similar costs to CAI patients (N = 208 pairs). The difference in cost-reduction between CAI and comparison patients was used to compute the adjusted Return on Investment (aROI).

Results

There were no significant differences between CAI and comparison groups, including baseline age (5.9 years [SD 2.9] v. 4.4 [SD 3.1]); Hispanic (46.2% v. 35.1%) and Black (43.9% v. 53.0%) race/ethnicity; and public insurance (71.2% v. 68.8%). The cost reduction difference for CAI was significant at one year (P = 0.0001) and two years (P = 0.03), but did not reach the level of significance for years 3-10. The CAI group had a greater cumulative cost reduction of $5,321 (P = 0.08, not significant). Average program cost per patient was $2,636. CAI broke-even after 3 years (aROI = 1.04) and yielded an adjusted ROI of 1.99 at 10 years.

Conclusions

The greater reduction in cumulative cost for CAI patients suggested a shift in trajectory at 10 years of follow-up, resulting in a positive aROI after three years.

Keywords:

• Home visiting
• asthma
• nurse
• community health worker
• case management
• return on investment
• cost savings
• 10-year follow-up

Acknowledgments

The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government (see HRSA.gov). We appreciate the donation of vacuum cleaners from SharkNinja, Inc., for many of the families. The funders/sponsors did not participate in the work. We thank the Office of Community Health, Boston Children’s Hospital for their ongoing support and funding.

Declaration of conflicting interest

The authors have no conflicts of interest to disclose.

Additional information

Funding

This paper was supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a MCHB T71MC00009 LEAH training grant and a MCHB H17MC21564 Healthy Tomorrows grant.