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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)
Sean D. Sullivan, PhD;
Todd A. Lee, PharmD, PhD;
David K. Blough, PhD;
Jonathan A. Finkelstein, MD;
Paula Lozano, MD;
Thomas S. Inui, MD;
Anne L. Fuhlbrigge, MD;
Vincent J. Carey, PhD;
Ed Wagner, MD;
Kevin B. Weiss, MD; for the PAC-PORT II Team
Arch Pediatr Adolesc Med. 2005;159:428-434.
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, $1292; PLE, $504; and usual care, $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 $18 per SFD gained for PLE (95% CI, $5.21-dominated) and $68 per SFD gained for PACI (95% CI, $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.
Author Affiliations: Pharmaceutical Outcomes Research and Policy Program (Drs Sullivan and Blough) and Department of Pediatrics (Dr Lozano), University of Washington, Seattle; The Midwest Center for Health Services and Policy Research, Hines Veterans Affairs Hospital, Hines, Ill (Drs Lee and Weiss); Center for Healthcare Studies, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine (Drs Lee and Weiss), and Center for Pharmacoeconomic Research, Department of Pharmacy Practice, College of Pharmacy (Dr Lee), Chicago, Ill; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (Dr Finkelstein), and Department of Pediatrics (Dr Finkelstein) and Channing Laboratory (Drs Fuhlbrigge and Carey), Harvard Medical School, Boston, Mass; Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle (Drs Lozano and Wagner); and Regenstrief Institute for Health Care, Indianapolis, Ind (Dr Inui).
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