A multisite randomized trial of the effects of physician education and organizational change in chronic asthma care: cost-effectiveness analysis of the Pediatric Asthma Care Patient Outcomes Research Team II (PAC-PORT II).
BACKGROUND
A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact. The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies: a peer leader-based physician behavior change intervention (PLE) and a practice-based redesign called the planned asthma care intervention (PACI).


OBJECTIVE
To estimate the cost-effectiveness of the interventions.


METHODS
This was a 3-arm, cluster randomized trial conducted in 42 primary care practices. A total of 638 children (age range, 3-17 years) with mild to moderate persistent asthma were followed up for 2 years. Practices were randomized to PLE (n = 226), PACI (n = 213), or usual care (n = 199). The primary outcome was symptom-free days (SFDs). Costs included asthma-related health care utilization and intervention costs.


RESULTS
Annual costs per patient were as follows: PACI, USD 1292; PLE, USD 504; and usual care, USD 385. The difference in annual SFDs was 6.5 days (95% confidence interval [CI], -3.6 to 16.9 days) for PLE vs usual care and 13.3 days (95% CI, 2.1-24.7 days) for PACI vs usual care. Compared with usual care, the incremental cost-effectiveness ratio was USD 18 per SFD gained for PLE (95% CI, USD 5.21-dominated) and USD 68 per SFD gained for PACI (95% CI, USD 37.36-361.16).


CONCLUSIONS
Results of this study show that it is possible to increase SFDs in children and move organizations toward guideline recommendations on asthma control in settings where most children are receiving controller medications at baseline. However, the improvements were realized with an increase in the costs associated with asthma care.
Sullivan
Sean D
SD
Pharmaceutical Outcomes Research and Policy Program and Department of Pediatrics, University of Washington, Seattle, WA 98195, USA. sdsull@u.washington.edu
Lee
Todd A
TA
Blough
David K
DK
Finkelstein
Jonathan A
JA
Lozano
Paula
P
Inui
Thomas S
TS
Fuhlbrigge
Anne L
AL
Carey
Vincent J
VJ
Wagner
Ed
E
Weiss
Kevin B
KB
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D004502:Education, Medical, Continuing / Q000191:economics* / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D010372:Pediatrics / Q000193:education*; D010818:Practice Patterns, Physicians'; D014481:United States
D018927:Anti-Asthmatic Agents