In a survey <strong>of</strong> nearly 400 p<strong>at</strong>ients tre<strong>at</strong>ed in alarge health maintenance organiz<strong>at</strong>ion,significant quality <strong>of</strong> life improvements werereported by p<strong>at</strong>ients tre<strong>at</strong>ed by allergists,compared to those tre<strong>at</strong>ed by generalists or inthe emergency department. Improvements wereseen in physical function, emotion, pain reliefand general health. [31]In a suburban priv<strong>at</strong>e practice, p<strong>at</strong>ients weresurveyed after the initi<strong>at</strong>ion <strong>of</strong> an asthmamanagement program th<strong>at</strong> was supervised by anasthma specialist. The p<strong>at</strong>ients reported significantimprovements in their ability to particip<strong>at</strong>e inactivities, their emotional well being and in thecontrol <strong>of</strong> asthma symptoms. [32]Asthma Tre<strong>at</strong>ment <strong>Cost</strong>sNumerous studies have shown th<strong>at</strong> aggressivemanagement and tre<strong>at</strong>ment <strong>of</strong> asthma by anallergist not only produces better healthoutcomes, but also can reduce costs rel<strong>at</strong>ed tothe disease.For example, one large, urban specialty asthmacenter estim<strong>at</strong>ed th<strong>at</strong> specialty care reducedinsurance claims for asthma-rel<strong>at</strong>ed services by45 percent to 80 percent. [27]In a study sponsored by the Asthma and<strong>Allergy</strong> Found<strong>at</strong>ion <strong>of</strong> America, a 54 percentincrease in the cost <strong>of</strong> asthma care wasdocumented between 1985 and 1994 while, <strong>at</strong>the same time, de<strong>at</strong>hs from the disease rose by41 percent. The increased costs reflected asteep rise in medic<strong>at</strong>ion costs, yet nine out <strong>of</strong>10 prescriptions were for “rescue” medic<strong>at</strong>ionsto manage severe asthma <strong>at</strong>tacks, r<strong>at</strong>her thanfor inhaled corticosteroids used to prevent such<strong>at</strong>tacks. The study’s authors concluded th<strong>at</strong> theresults indic<strong>at</strong>ed th<strong>at</strong> many p<strong>at</strong>ients were notbeing tre<strong>at</strong>ed according to establishedguidelines. [33]Even when asthma p<strong>at</strong>ients <strong>at</strong>tend frequentclinic programs <strong>of</strong>fering intensive specialtyservices, costs are saved in the long-term byreducing the number <strong>of</strong> emergency room visitsand other acute care interventions. In onecenter, a savings <strong>of</strong> $137 per p<strong>at</strong>ient per yearwas realized among p<strong>at</strong>ients who madefrequent, regular visits to a comprehensiveallergy clinic, compared to p<strong>at</strong>ients who wentless frequently to an emergency room fortre<strong>at</strong>ment <strong>of</strong> acute asthma symptoms. [29]Other research has documented th<strong>at</strong> the servicesin specialty clinics result in a higher quality <strong>of</strong>care, including str<strong>at</strong>egies to help p<strong>at</strong>ients controltheir disease and reduce the incidence <strong>of</strong> acutesymptoms th<strong>at</strong> require hospitaliz<strong>at</strong>ion oremergency room services. [34]Failure to control asthma has a particularlyhigh price. It has been estim<strong>at</strong>ed th<strong>at</strong> morethan 80 percent <strong>of</strong> all resources expended forasthma tre<strong>at</strong>ment is used by 20 percent <strong>of</strong>p<strong>at</strong>ients whose disease is not adequ<strong>at</strong>elycontrolled. [35]Hospitaliz<strong>at</strong>ionsAsthma is responsible for nearly one-halfmillion hospital admissions annually, whichcost an estim<strong>at</strong>ed $4.7 billion. [4] P<strong>at</strong>ientsunder the care <strong>of</strong> allergists are hospitalized less<strong>of</strong>ten for asthma symptoms and have shorterlengths <strong>of</strong> stay, which can dram<strong>at</strong>ically lowerthe cost <strong>of</strong> inp<strong>at</strong>ient asthma care.In a retrospective study <strong>of</strong> 70 p<strong>at</strong>ients withmoder<strong>at</strong>e-to-severe asthma, decreasedhospitaliz<strong>at</strong>ions after evalu<strong>at</strong>ion by an allergistcontributed to an overall savings <strong>of</strong> $145,500,or $2,100 per p<strong>at</strong>ient. [30] In another study <strong>of</strong>p<strong>at</strong>ients requiring intub<strong>at</strong>ion for asthma,enrollment in an intervention programsupervised by asthma specialists saw perp<strong>at</strong>ienthospital costs reduced 95 percent from$40,253 to $1,926. [36]10
Emergency Room VisitsInp<strong>at</strong>ient Care <strong>Cost</strong>s$50K$40K$30K$20K$10K$40,25395%reductionfor inp<strong>at</strong>ientcare costswith asthmaspecialists$1,926The most recent d<strong>at</strong>a on the cost <strong>of</strong> emergencyroom visits for asthma is estim<strong>at</strong>ed to be morethan $546 million annually. [5]In a study <strong>of</strong> 207 asthma p<strong>at</strong>ients tre<strong>at</strong>ed byspecialists <strong>at</strong> one Midwest asthma center,reductions in hospitaliz<strong>at</strong>ions and emergencyroom visits were substantial, representing anannual cost savings <strong>of</strong> $2,714 per p<strong>at</strong>ient –more than $560,000. [32] Another studyreported a fall in emergency department visitsfrom 74 to 17, and cost reductions <strong>of</strong> $34,706to $7,973, for 125 p<strong>at</strong>ients after they enrolledin a specialty asthma clinic. [26]$0Non-SpecialistCareSpecialistCareASTHMA CAREHOSPITAL INPA TIENTCOST SAVINGSSource: Doan, et al. Ann <strong>Allergy</strong> Asthma Immunol. 1996.$35K$30K$25K$34,70677%reduction inemergencyroom costswith asthmaspecialistsYet another study <strong>of</strong> 125 p<strong>at</strong>ients showed th<strong>at</strong>the number <strong>of</strong> hospitaliz<strong>at</strong>ions decreased from38 to four, and the costs <strong>of</strong> inp<strong>at</strong>ient caredropped from $192,926 to $20,308, after thep<strong>at</strong>ients were enrolled in a specialty allergyclinic. [26]ER <strong>Cost</strong>s$20K$15K$10K$7,973There was a 60 percent reduction in totalhospitaliz<strong>at</strong>ions in a study <strong>of</strong> nearly 100 adultswho were enrolled in a specialty asthmaprogram. The study also found a markedreduction in lost work or school days, anddocumented a savings <strong>of</strong> $6,462 per p<strong>at</strong>ientover a six-month period. [25]$5K$0Non-SpecialistCareSpecialistCareASTHMA CAREEMERGENCY ROOMCOST SAVINGSSource: Villanueva, et al.<strong>American</strong> <strong>College</strong> <strong>of</strong> Chest Physicians Annual Meeting 2000.11
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