Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations

Abstract

This prospective study of 169 adult patients hospitalized for severe acute asthma in four pneumology wards compared the incidence and costs of patients who were managed (group A) or not managed (group P) before hospitalization, according to the guidelines and international recommendations (11 criteria judged by experts). Ambulatory costs were calculated by questioning patients. Valuation of hospital costs was based DRGs weighted by length of stay. The incidence in group P patients was estimated at 70%; A patients were 14 years younger than those in group P and had less severe asthma. Their annual ambulatory care prior to hospitalization was less costly irrespective of age category or degree of severity (euro 685 vs. euro 1,145 in group A); their length of hospital stay was shorter (6.03 vs. 10.78 days), resulting in a lower cost of hospitalization (euro 2,820 vs. euro 4,843). In group P a specific education program based on increased understanding, compliance, self-management, and smoking cessation, particularly in young patients should lead to reductions in hospitalizations.

Economic burden of asthma: a systematic review

“…Stanford and associates reported resources such as nursing care, respiratory therapy, and ED-specific supplies along with equipment use and physician fees to account for the majority of hospital costs of asthma; 44%, 11% and 53% of the costs, respectively [ 36 ]. The results of the cost estimation for asthma hospitalization in Quebec for the year 1994/95 indicated that of the total cost of $23.3 million, the greatest proportion was accounted for by pediatric patients ($11 million) [ 57 ]. Similar findings in a retrospective cohort study also suggested that although teaching hospitals in their study were not found to have higher charges, children's hospitals appeared to be more expensive due to the inherent responsibilities of a teaching hospital, but also due to the fact that they act as regional referral centers with specialized services for children [ 25 ].…”

“…The significant contribution of direct healthcare costs due to hospitalization in studies is not surprising given the inherent high costs associated with acute care versus ambulatory care [ 14 , 15 , 20 , 28 , 30 , 36 , 38 , 42 , 48 - 50 , 53 - 57 , 65 , 72 ]. Variations in the cost of hospitalization are likely related to the differences in the socioeconomic environment, that is, the difference in the gross national income per capita, or more specifically differences in salary costs in different countries.…”

“…The reasons that children with asthma reported higher healthcare costs compared to non-asthma conditions could be related to: higher use of ambulatory care and medications for upper respiratory tract infections or conditions that can act synergistically with asthma (such as respiratory infections, otitis, sinusitis, etc), the use of day-care centers, experiencing more severe asthma on average and higher healthcare use in general, and misclassification of asthma-related encounters as "non-asthma" [ 24 , 25 , 30 , 40 - 43 , 57 , 62 , 70 , 71 ]. However, for adults, the increased total costs and increased costs per affected person could be explained by either an increase in the severity of asthma or a decrease in the use of effective healthcare resources.…”

Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations

“…(26) defined three populations of asthmatic patients: near‐fatal acute asthma, emergency admission for acute asthma, and out‐patients; 37% of the 197 patients admitted to emergency department for acute asthma were considered to be suffering from mild asthma (Table 5). Finally, in a French study (27) of 169 emergency admissions for asthma, asthma was classified as intermittent in nearly 30% of cases and as mild persistent in 20%.…”

A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy

“…Asthma continues to be a national and international health priority. 1,2 A pediatric study in 2011 showed that although the rate of admission for asthma decreased by one-half during a 15-year period, the rate of critical asthma care tripled and hospital costs increased from $6.6 million to $9.5 million for a single state. 3 Two reviews of the Pediatric Health Information System found marked regional variations in the choice of critical asthma medical interventions when children did not improve with standard therapy (inhalation of b-agonists and steroids).…”