Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Abstract

The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches.A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches.There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n=14) versus 187(n=41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor9s visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care.Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

“…balance of primary care provided by nurses versus GPs, availability and use of telephone advice lines) 165,166 • HRQoL. 160,165,167 Summary points of the economic impact of asthma…”

Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up

“…First, nurse-led outpatient management can be provided at a lower cost than medical care by a paediatrician. 32 Second, it frequently happens in daily practice that acute cases and concerns take priority over the less urgent need to bring chronic illness under optimal management; Bodenheimer et al call this "the tyranny of the urgent". 13 Separating chronic care from acute and urgent care in an organisation is a major step in optimising the management of chronic illness.…”

Health economics of asthma: assessing the value of asthma interventions

“…Of the 14 policy evaluations six considered the economic effects of implementing an education program (22,24,25,28,30,32). Other studies evaluated management programs (23,26,29,33,35), guidelines (27), and surveillance (31,34). All 26 of the pharmaceutical comparisons were of controller medications.…”

“…Tables 1-4 contain detailed information on each of the economic evaluations organized by their intervention of interest: policy interventions (Table 1), monotherapy controller medications (Table 2), combination controller medications (Table 3), and add-on medications (Table 4). Of the 40 papers that we reviewed, 14 evaluated a policy intervention (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and the other 26 were pharmaceutical comparisons . Of the 14 policy evaluations six considered the economic effects of implementing an education program (22,24,25,28,30,32).…”