Cost-effectiveness of physician peer leader education and practice-based redesign in managed care: The pediatric asthma care PORT-II trial

Sullivan, S.; Lee, T.; Blough, D.; Finkelstein, J.; Lozano, P.; Inui, T.; Inui, T.; Carey, V.; Wagner, E.; Fuhlbrigge, A.; Weiss, K.

doi:10.1016/j.jaci.2004.01.729

« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 113, Issue 2, Supplement , Page S339, February 2004

Cost-effectiveness of physician peer leader education and practice-based redesign in managed care:☆

The pediatric asthma care PORT-II trial

S. Sullivan
- Department of Pharmacy, University of Washington, Seattle, WA, USA
T. Lee
- Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, ILUSA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
D. Blough
- Department of Pharmacy, University of Washington, Seattle, WA, USA
J. Finkelstein
- Harvard Medical School and Harvard Pilgrim Healthcare, Boston, MA, USA
P. Lozano
- Center for Healthcare Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
T. Inui
- Regenstrief Institute for Healthcare, Indianapolis, IN, USA
T. Inui
- Regenstrief Institute for Healthcare, Indianapolis, IN, USA
V. Carey
- Harvard Medical School, Boston, MA, USA
E. Wagner
- Center for Healthcare Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA
A. Fuhlbrigge
- Harvard Medical School, Boston, MA, USA
K. Weiss
- Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, ILUSA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Abstract

Rationale

A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact. The Pediatric Asthma Care PORT II trial evaluated the outcomes of two asthma care strategies in children (ages 3 – 17) – a peer leader based physician behavior change intervention (PLE) and a practice-based redesign (Planned Asthma Care Intervention (PACI)). The purpose of this study is to estimate the cost-effectiveness of the interventions.

Methods

This was a three-arm cluster randomized trial conducted in 41 primary care practices within 3 managed care organizations. 638 children with mild to moderate persistent asthma were observed for up to two years. Practices were randomized to PLE (N=226), PACI (N=213) or usual care (N=199). The primary outcome was average symptom-free days (SFD) estimated from GEE models. Costs for the interventions, asthma-related hospitalizations, ED visits, office visits and medications were included. Non-medical costs were excluded.

Results

Mean annual costs per patient were: PACI=$1436, PLE=$970 and Usual Care=$388. The incremental difference in annual SFD for the interventions compared to usual care was 6.5 (95% CI −3.6 to 16.9 days) for PLE and 13.3 (95% CI 2.1 to 24.7 days) for PACI. Compared to usual care the incremental cost-effectiveness ratio (ICER) was $90 per SFD gained for PLE and $79 per SFD gained for PACI. In subgroup analyses, ICERs varied by child's age and baseline medication use.