Asthma outcomes: Healthcare utilization and costs

https://doi.org/10.1016/j.jaci.2011.12.984Get rights and content

Background

Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost.

Objective

National Institutes of Health institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in future asthma studies.

Methods

We used comprehensive literature reviews and expert opinion to compile a list of asthma healthcare utilization outcomes that we classified as core (required in future studies), supplemental (used according to study aims and standardized), and emerging (requiring validation and standardization). We also have identified methodology to assign cost to these outcomes. This work was discussed at an National Institutes of Health–organized workshop in March 2010 and finalized in September 2011.

Results

We identified 3 ways to promote comparability across clinical trials for measures of healthcare utilization, resource use, and cost: (1) specify the study perspective (patient, clinician, payer, and society); (2) standardize the measurement period (ideally 12 months); and (3) use standard units to measure healthcare utilization and other asthma-related events.

Conclusions

Large clinical trials and observational studies should collect and report detailed information on healthcare utilization, intervention resources, and indirect impact of asthma, so that costs can be calculated and cost-effectiveness analyses can be conducted across several studies. Additional research is needed to develop standard, validated survey instruments for collection of provider-reported and participant-reported data regarding asthma-related health care.

Section snippets

Definition and methodology for measurement

Collecting and reporting asthma-related events and resource utilization make it possible to compare events and outcomes across studies and to achieve a more complete and standardized accounting of resource use. Healthcare events include:

  • hospitalizations;

  • ED visits;

  • unscheduled outpatient visits;

  • scheduled (preventive) outpatient visits;

  • subspecialist care; and

  • remote care.

For the purposes of measuring healthcare utilization and cost, each healthcare event and occurrence of resource use (eg, short

Cost and cost-effectiveness analysis

The section below provides an overview of methods for assigning value to measured units of healthcare utilization, other intervention-related resources, and other outcomes that contribute to the direct and indirect costs of asthma interventions and morbidity. An important consideration across all types of resources when valuing an intervention is distinguishing between those activities that relate to research and those that are part of the intervention. Under most circumstances, the research

Future directions

The subcommittee identified 4 priority topics for additional research:

  • 1.

    Development of survey instruments. Analysts sometimes rely on poorly validated convention and historical documents from national surveys to elicit measures of healthcare utilization from patients and providers. Development of standardized and validated survey instruments for prospective and retrospective data collection for asthma healthcare and other asthma-related events for both provider-reported and participant-reported

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  • Cited by (0)

    The Asthma Outcomes workshop was funded by contributions from the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; the Agency for Healthcare Research and Quality; and the Merck Childhood Asthma Network, as well as by a grant from the Robert Wood Johnson Foundation. Contributions from the National Heart, Lung, and Blood Institute; the National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; and the US Environmental Protection Agency funded the publication of this article and all other articles in this supplement.

    Disclosure of potential conflict of interest: S. D. Sullivan has received research support from Merck. J. D. Campbell is a consultant for VeriTech Corp and has received research support from the Agency for Healthcare Research and Quality. R. W. Grundmeier has received research support from AHRQ, the NIH, and MCHB. T. V. Hartert has received research support from the NIH and AHRQ; is an Associate Editor for the ATS; and is a consultant for Merck. The rest of the authors declare that they have no relevant conflicts of interest.

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