An intervention program to reduce the hospitalization cost of asthmatic patients requiring intubation

Background: Asthma is the single disease that accounts for the largest proportion of total health care cost in the US. Objective: To analyze whether an asthma management program affected the cost of subsequent asthma care for patients in whom intubation had been necessary. Methods: We evaluated patients with asthma who (1) had required intubation for treatment of status asthmaticus; (2) were 45 years old or younger; (3) had regular follow-up visits in our clinic for 1 year after initial evaluation; and (4) had complete medical records 1 year before and 1 year after the intervention for our evaluation. Medical costs of asthma treatment for each patient were determined for 1 year before and 1 year after intervention. The program included patient education, regular outpatient visits, specialist care, and access to the Allergy Immunology emergency call service. The outcome measures were the total cost of care, inpatient hospitalizations, outpatient services, emergency services, and medicine costs. Results: Nine patients [mean age 19.6 years (SD = 9.9)] fulfilled the criteria (six women and three men). The mean duration of asthma was 14.0 years (SD = 9.7). The mean total cost of care decreased from $43,066 to $4,914 (t = -4.53, P < .001) and inpatient hospitalization costs decreased from $40,253 to $1,926 (t = -4.50, P < .001). There was, however, no significant difference in the mean pre-intervention versus post-intervention cost of emergency services, outpatient services, or medicine costs. Conclusions: The intervention-which included education, specialist care, regular outpatient visits, and access to an emergency call service-si,gnificantly reduced the cost of asthma care in our population of patients intubated for asthma.