Abstract
Objectives: To identify the asthma prevalence rate, the total healthcare and asthma-related treatment costs, and the medical and pharmacy costs associated with different asthma medication usage patterns in a managed-care organisation (MCO).
Study design and participants: The medical and pharmacy claims databases from a 400 000 member MCO were used. The medical claims database was searched from 1994 to 1996 for patients having at least one asthma medical claim in either the first or second diagnosis field of the medical claims, and the total healthcare and asthma-related costs were determined. A subpopulation with a more restrictive asthma definition was identified and their costs were also determined. In addition, the patterns of drug treatment were identified.
Study perspective: MCO perspective.
Results: The mean total healthcare cost of caring for patients with asthma was significant and approximately twice the mean cost of all patients enrolled in the MCO. Using a broad definition of asthma, the mean (± standard deviation) annual total per patient healthcare cost was $US2511 ± 7314 and the annual asthma-related cost was $US679 ± 2247 (1996 values). Using a more restrictive definition of asthma, the mean annual total per patient healthcare cost was $US2653 ± 5268 and the asthma-related cost was $1026 ± 2447. There appeared to be a low overall use of asthma medications, especially anti-inflammatory formulations; <3% of patients with asthma were high users of anti-inflammatory inhalers.
Conclusions: Patients with asthma are costly to managed-care organizations. Asthma-related costs constitute a minority (<30%) of the costs of caring for these patients, and under utilization of anti-inflammatory products by patients is widespread. Further research is needed to assess the cost impact of different asthma treatment patterns.
Similar content being viewed by others
References
Brabowski H, Mullins CD. Pharmacy benefit management, cost-effectiveness analysis and drug formulary decisions. Soc Sci Med 1997; 45: 535–44
Holdford DA. Barriers to disease management. Am J Health Syst Pharm 1996; 53: 2093–6
Zitter M. Disease management: a new approach to health care. Med Interface 1994; Aug: 70–6
Harris Jr JM. Disease management: new wine in new bottles? Ann Intern Med 1996; 124: 838–42
Landis NT. Disease management entries multiply, diversify. Am J Health Syst Pharm 1995; 52: 1268, 1271–2
Epstein RS, Sherwood LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med 1996; 124: 832–7
Schectman JM, Kanwal NK, Schroth WS, et al. The effect of an education and feedback intervention on group-model and network-model health maintenance organization physician prescribing behavior. Med Care 1995; 33: 139–44
Summers KH. Measuring and monitoring outcomes of disease management programs. Clin Ther 1996; 18: 1341–8
Curtiss FR. Lessons learned from projects in disease management in ambulatory care. Am J Health Syst Pharm 1997; 54: 2217–9
Gehlback SH, Wilkinson WE, Hammond WE, et al. Improving drug prescribing in a primary care practice. Med Care 1984; 22: 193–201
Armstrong EP. Monitoring and evaluating disease management: information requirements. Clin Ther 1996; 18: 1327–33
Martin RE. Designing as asthma disease management program in a managed care environment. Formulary 1997; 32: 269–72, 277–8
National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program, Expert Panel Report 2. Guidelines for the diagnosis and management of asthma. Bethesda (MD): US Department of Health and Human Services, 1997. NIH publication no. 97–4051
Buchner DA, Butt LT, De Stefano A, et al. Effects of an asthma management program on the asthmatic member: patientcentered results of a 2-year study in a managed care organization. Am J Managed Care 1998; 4: 1288–97
Barnes PJ. Medical intelligence drug therapy: a new approach to the treatment of asthma. N Engl J Med 1989; 321: 1517–27
Self TH, Strayhorn VA. Long-term management of asthma. Pharmacists can help improve outcomes by ensuring compliance with NIH Guidelines for asthma management. J Am Pharm Assoc 1997; N Suppl. 37: 422–38
Bernstein IL, Blessing-Moore J, Fineman S, et al. Establishing practice parameters: parameters for the diagnosis and treatment of asthma. Ann Allergy 1993; 71: 197–8
Feder G, Griffiths C, Highton C, et al. Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? Arandomised controlled trial in general practices in east London. BMJ 1995; 311: 1473–8
Greineder DK, Loane KC, Parks P. Reduction in resource utilization by an asthma outreach program. Arch Pediatr Adolesc Med 1995; 149: 415–20
Higenbottam T, Hay I. Has the treatment of asthma improved? Chest 1990; 98: 706–12
Jones KP, Harris CM, Bogle SM, et al. The effects on prescribing patterns and costs of having a special interest in asthma. J R Soc Med 1995; 88: 570–99
Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81–7
Kemp JP. Approaches to asthma management: realities and recommendations. Arch Intern Med 1993; 153: 805–12
Martin RJ. Management of patient with chronic asthma: controversies and future directions. Ann Allergy 1994; 72: 390–2
McFadden Jr ER, Elsanadi N, Dixon L, et al. Protocol therapy for acute asthma: therapeutic benefits and cost savings. Am J Med 1995; 99: 651–1
O’Brien KP. Managed care and the treatment of asthma. J Asthma 1995; 32: 325–4
Pearson MG. Asthma guidelines: who is guiding whom and where to? Thorax 1993; 48: 197–8
Persaud DI, Barnett SE, Weller SC, et al. An asthma self-management program for children, including instruction in peak flow monitoring by school nurses. J Asthma 1996; 33: 37–43
Wennergren G, Kristjansson S, Strannegard IL. Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in prevalence of asthma. J Allergy Clin Immunol 1996; 97: 742–8
Fuller MG. Disease state managementprogrammes: approaches and applications. Dis Manage Health Outcomes 1999; 6: 29–36
Gurnee MC, DaSilva RV. Constructing disease state management programs. Managed Care Pharm Pract 1995; Jul/Aug: 30–8
Zalta E, Eichner H, Henry M. Implications of disease management in the future of managed care. Med Interface 1994 Dec: 66–9, 78
Armstrong EP, Langley PC. Disease management programs. Am J Health Syst Pharm 1996; 53: 53–8
Armstrong EP. Disease management: state of the art and future directions. Clin Ther 1999; 21: 593–609
Armstrong EP, Manuchehri F. Ambulatory care databases for managed care organizations. Am J Health Syst Pharm 1997; 54: 1973–83
Selby JV. Linking automated databases for research in managed care settings. Ann Intern Med 1997; 127: 719–24
Lewis NJW, Patwell JT, Briesacher BA. The role of insurance claims databases in drug therapy outcomes research. Pharmacoeconomics 1993; 4: 323–0
Starfield B, Mumford L. Ambulatory care groups: a categorization of diagnoses for research and management. Health Serv Res 1991; 26: 53–74
McNeil BJ, Pedersen SH, Gatsonis C. Current issues in profiling quality of care. Inquiry 1992; 29: 298–307
Motheral BR, Fairman KA. The use of claims databases for outcomes research: rationale, challenges, and strategies. Clin Ther 1997; 19: 346–66
McDonald CJ, Overhage M, Dexter P, et al. A framework for capturing clinical data sets from computerized sources. Ann Intern Med 1997; 127: 675–82
Arnold RG, Kotsanos JG, Motheral B, et al. Panel 3: methodological issues in conducting pharmacoeconomic evaluations — retrospective and claims database studies. Value Health 1999; 2: 82–7
Weiner JP, Parente ST, Garnick DW, et al. Variation in officebased quality. A claims-based profile of care provided to medicare patients with diabetes. JAMA 1995; 273: 1503–8
Iezzoni LI. Assessing quality using administrative data. Ann Intern Med 1997; 127: 666–74
Chrischilles EA. The contribution of epidemiology to pharmacoeconomic research. Drug Inf J 1992; 26: 219–9
Hornberger J, Wrone E. When to base clinical policies on observational versus randomized trial data. Ann Intern Med 1997; 127: 697–703
Glauber HS, Brown JB. Use of health maintenance organization data bases to study pharmacy resource usage in diabetes mellitus. Diabetes Care 1992; 15: 870–6
Else BA, Armstrong EP, Cox ER. Data sources for pharmacoeconomic and health services research. Am J Health Syst Pharm 1997; 54: 2601–8
Ray WA. Policy and program analysis using administrative databases. Ann Intern Med 1997; 127: 712–8
Palmer RH. Process-based measures of quality: the need for detailed clinical data in large health care databases. Ann Intern Med 1997; 127: 733–8
Larson LN, Bjornson DC. Interface between pharmacoepidemiology and pharmacoeconomics in managed care pharmacy. J Managed Care Pharm 1996; 2: 282–9
Weiner JP, Powe NR, Steinwachs DM, et al. Applying insurance claims data to assess quality of care: a compilation of potential indicators. QRB Qual Rev Bull 1990; 16: 424–38
Piecoro LT, Wang LS, Dixon WS, et al. Creating a computerized database from administrative claims data. Am J Health Syst Pharm 1999; 56: 1326–9
Avorn J. Epidemiology in Plato’s care: claims data and clinical reality. J Clin Epidemiol 1991; 44: 867–9
Whittle J, Steinberg EP, Anderson GF, et al. Accuracy of medicare claims data for estimation of cancer incidence and resection rates among elderly Americans. Med Care 1991; 29: 1226–36
Quam L, Ellis LBM, Venus P, et al. Using claims data for epidemiologic research. The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population. Med Care 1993; 131: 498–507
Jollis JG, Ancukiewicz M, DeLong ER, et al. Discordance of databases designed for claims payment versus clinical information systems. Ann Intern Med 1993; 119: 844–50
Roos LL, Sharp SM, Cohen MM. Comparing clinical information with claims data: some similarities and differences. Clin Epidemiol 1991; 44: 881–8
Lloyd SS, Rissing JP. Physician and coding errors in patient records. JAMA 1985; 254: 1330–6
Hennekens CH, Buring JE, Mayrent SL, editors. Epidemiology in medicine. Boston (MA): Little, Brown and Company, 1987
1996 Asthma: United States, 1982-1992. MMWR Morb Mortal Wkly Rep 1996; 45: 350–3
Bonner JR. The epidemiology and natural history of asthma. Clin Chest Med 1984; 5: 557–65
Smith DH, Malone DC, Lawson KA, et al. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med 1997; 156: 787–93
Trubitt MJ. United HealthCare of Illinois working to improve asthma care. Chest 1999; 116 Suppl.: 208S–9
Sullivan SD, Weiss KB. Assessing cost-effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies. Allergy 1993; 48: 146–52
MacKinnon NJ, Flagstad MS, Peterson CR. et al. Disease management program for asthma: baseline assessment of resource use. Am J Health Syst Pharm 1996; 53: 535–41
Li JT, Xakellis G, Edell ES, et al. Concentration of healthcare costs in asthma. Am J Manag Care 1995; 1: 137–40
Lozano P, Fishman P, VonKorff M, et al. Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization. Pediatrics 1997; 99: 757–64
Lozano P, Sullivan SD, Smith DH, et al. The economic burden of asthma in US children: estimates from the National Medical Expenditure Survey. J Allergy Clin Immunol 1999; 104: 957–63
Stroupe KT, Gaskins D, Murray MD. Health-care costs of inner-city patients with asthma. J Asthma 1999; 36: 645–55
Legorreta AP, Christian-Herman J, O’Connor RD, et al. Compliance with national asthma management guidelines and specialty care. A health maintenance organization experience. Arch Intern Med 1998; 158: 457–64
Acknowledgements
This study was funded through a full research grant from Rhone-Poulenc Rorer to The University of Arizona. No author owns stock in this company. Drs Armstrong and Langley have given presentations and received honoraria from Rhone-Poulenc Rorer.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Armstrong, E.P., Krueger, K. & Langley, P.C. Analysis of Asthma-Related Costs and Patterns of Resource Utilization in a Managed-Care Population. Dis-Manage-Health-Outcomes 9, 161–171 (2001). https://doi.org/10.2165/00115677-200109030-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-200109030-00004