An economic evaluation of short-term inpatient rehabilitation for children with severe asthma
The cost of asthma care in the United States in 1990 has been estimated to be 6.2 billion dollars. The greatest proportion is due to hospital care.
We report changes in estimated medical charges of 59 children with severe asthma 1 year before inpatient rehabilitation and over a 4-year follow-up period.
Asthma resource use (e.g., hospital, physician, medication) was identified before and after inpatient rehabilitation. Estimated charges were assigned. This was done retrospectively for the 1-year period before rehabilitation, prospectively during rehabilitation, and over a 4-year follow-up period. Patients served as their own controls. There was no control group.
When median asthma resource use 1 year before rehabilitation was compared with that during the first, second, third, and fourth years of follow-up, there was a reduction in median hospitalization and median emergency care. Compared with mean total medical charges the year before rehabilitation, reductions in mean total medical charges were 56.7% at the completion of the first year (excluding charges for rehabilitation), 70.5% at second year, 74.6% at third year, and 77.5% at fourth year. Over the 4-year postrehabilitation period, the discounted cumulative net savings was $29,605. The discounted cumulative net savings surpassed the mean rehabilitation charge during the early months of the fourth year of the postrehabilitation period.
Inpatient rehabilitation was significantly associated with a reduction in estimated total medical charges over a 4-year follow-up period.
Available from: Soeren Mattke
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ABSTRACT: Comprehensive care for the severely asthmatic child includes psychological as well as medical treatment. Family therapy is a recognized modality of therapy. Investigations have examined the role of emotion and asthma as well as psychosomatic asthma. Pharmacological treatment of beta 2-agonist and cromolyn prior to disciplining the child prevents psychosomatic asthma secondary to crying or shouting. Adherence to multiple asthma therapeutic modalities is imperative, and a psychological and medical team can address these important clinical issues in a high-risk population.
Available from: Vicente Plaza
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ABSTRACT: An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.
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