Abstract
Introduction: The Intensive Management of Asthma Clinic (IMAC) is a novel multidisciplinary clinic for children with problematic severe asthma. The cost of maintaining such a clinic compared to a standard asthma clinic has not been studied.
Objective: The purpose of the study was to examine the cost impact of consolidating resources in the IMAC. We hypothesized that there would be an overall cost saving in healthcare utilization, compared to patients managed in a standard asthma clinic.
Methods: This quasi-experimental retrospective study compared all patients enrolled in the IMAC between 2008-2011 and patients (<18 yrs) with problematic severe asthma in the standard asthma clinic at Alberta Children's Hospital, Calgary, Canada. Data on healthcare utilization (clinic visit, ED, hospitalization) was collected previously, and combined with costing data, including patient-borne costs. This was grouped and analyzed in 3-month intervals 2 years prior and after time 0 (1st IMAC visit, or met criteria for severe asthma). Primary analyses used linear mixed effects modeling.
Results:
| IMAC | Standard | |
| Clinic | 328(246 to 411) | 4(-74 to 82) |
| ED | -70(-90 to -51) | -33(-47 to -20) |
| Hospitalization | -135(-197 to -73) | -135(-197 to -73) |
| Patient-borne | -54(-91 to -16) | -54(-91 to -16) |
Difference in costs over time, $(CAD), 95% CI
Across patients and the time intervals, there was a mean net savings in the standard clinic of $218, and a mean net spending in the IMAC of $69.
Conclusion: The IMAC reduced unplanned ED visits and hence costs, but may be more expensive than standard asthma intervention. Decision-makers must judge whether benefits associated with multidisciplinary clinics are worth the potential additional resources required.
- Copyright ©the authors 2016
