Self-Management Education, Vaccines, Other Asthma Interventions Could Reduce Health Spending and Utilization

A study on Medicaid-enrolled children with asthma found that implementing several widely available interventions could reduce health care expenditures and utilization of hospital services, according to the results published in Journal of Asthma.

"This work shows that you can improve the quality of life for children with asthma and you can reduce government spending by implementing these proactive interventions," said Julie Swann, PhD, MS, lead author of the study and head of the Edward P. Fitts Department of Industrial and Systems Engineering at North Carolina State University, in a statement.

According to the study, asthma affected 8.3% of children in the United States in 2016 and is the third leading cause of pediatric hospitalization. In 2013, the estimated cost of asthma treatment in the United States was $81.9 billion, or an average of $3728 per person. Overall, children missed 13.8 million days of school in 2013 because of asthma complications.

The researchers focused on 4 interventions—asthma self-management education (AS-ME), influenza vaccine, nebulizers, and spacers for inhalers—and assessed their impact on cost and hospital utilization using data from 74,043 patients (n = 59,685 from New York; n = 14,358 from MIchigan) aged 0 to 17 with persistent asthma enrolled in a Medicaid program in either state during 2010 and 2011.

Regression analysis showed that implementing AS-ME decreased the probability of emergency department (ED) utilization for patients by 13.4% in Michigan and 6% in New York. The probability of inpatient (IP) visits also decreased by 2.2% and 3.5%, respectively.

Flu vaccinations decreased the average IP utilization per patient by 50% in New York (0.06 to 0.03) and Michigan (0.04 to 0.03).

Regression results estimate that expenditure utilization was reduced by 16.4% in New York and 14.8% in Michigan, along with the probability of a primary care physician (PCP) visit, which itself decreased by 6% and 3.5%, respectively.

When implementing nebulizers, ED utilization decreased by 45% in Michigan and by 76% in New York. Additionally, the probably of an ED visit fell by 20.8% and 12.4%, respectively, for those who received a nebulizer in 2011. Nebulizers also reduced the likelihood of IP utilization by 1.6% in Michigan and 0.8% in New York.

Spacers, which are used in combination with an inhaler to ensure the proper dose is being administered, reduced the mean ED utilization by 20% in Michigan and 12.7% in New York and IP utilization by 43.8% and 40%, respectively. A reduction in the probability of ED and IP utilization was around 1% in Michigan and 2% in New York with the implementation of spacers.

For all interventions, the study results showed that utilization costs for patients who received an intervention decreased after the intervention was introduced.

Reductions in health care expenditures were similar for both states for flu vaccines (15% in Michigan, 16% in New York), nebulizers (11% in both states), and spacer interventions (16% and 11%, respectively).

The greatest differences in reductions for health care expenditures were seen among AS-ME interventions: 65% in Michigan vs 17% in New York. This was likely due to a difference in who was offering the program in each state. In Michigan, 65% of AS-ME programs took place in outpatient hospitals and 60% were administered by a PCP, whereas in New York, 77% took place in a physician’s office and pediatricians were the main providers responsible.

AS-ME, flu vaccines, and nebulizers also reduced spending on asthma medications by 15.04%, 15.6%, and 6%, respectively, in New York. Although more is spent on AS-ME, this intervention was also responsible for the largest reduction in health care utilization and expenditures compared with the other interventions studied.

“This analysis provides evidence to policymakers about the benefits of the interventions of influenza vaccines, spacers, AS-ME, and nebulizers on health outcomes of pediatric asthma patients,” the authors concluded. “Although the percentage of patients that benefited from the interventions were low, promoting these interventions in other states or health systems could decrease the utilization cost and the frequency of healthcare utilization by the sickest patients while improving medication compliance of patients.”

Reference

Yildirim M, Griffin P, Keskinocak P, O’Connor JC, Swann JL. Estimating the impact of self-management education, influenza vaccines, nebulizers, and spacers on health utilization and expenditures for Medicaid-enrolled children with asthma. J Asthma. Published online October 10, 2020. doi:10.1080/02770903.2020.1821056