The cost of a visit to the emergency department or hospitalization for a patient with asthma can range from $400 to a staggering $28,000, making a forceful argument for a continuum of care aimed at appropriate asthma management, according to Richard H. Stanford, PharmD, MS, a researcher with GlaxoSmithKline. He presented the results of a study on resource utilization for asthma events requiring emergency department visits and/or hospitalizations.
“We were trying to determine the cost of severe asthma exacerbations,” said Dr Stanford, that is, “patients who go to the emergency room or hospital for their asthma.”
This cross-sectional, retrospective, observational study reviewed patients admitted to the emergency department or hospital for asthma between January 1, 2008, and December 31, 2008. It included eligible patients with a discharge diagnosis of asthma from 411 hospitals from Premier’s Perspective Comparative Database.
Costs and length of stay were calculated for 3 cohorts: patients treated and discharged from the emergency department only; patients seen in the emergency department and subsequently admitted to the hospital; and patients evaluated in a non–emergency department setting and subsequently admitted as inpatients.
“We have a very large data set of inpatient hospitalizations and emergency room [visits], and over a year’s time, we looked at every emergency room and hospital event that occurred in over 400 hospitals,” Dr Stanford said.
A total of 149,319 patients with events were identified, with 108,569 for emergency department only, 30,829 for emergency department plus inpatient, and 9921 for inpatient only.
For patients who visited the emergency department only, the average cost was $391.56; for emergency department patients subsequently admitted to the hospital, the average length of stay was 3.76 days, with a cost of $5911.34. Inpatient-only patients had a length of stay of 3.56 days, and a cost of $5039.97. Nursing care was the primary source of hospital costs for asthma, followed by medications and respiratory therapy.
“Overall cost of care is higher if they move from the emergency department into the inpatient setting,” Dr Stanford said. “That’s because emergency department costs are rolled into that. The standard inpatient visit costs health systems about $5000 per hospitalization for patients who get hospitalized for asthma, while emergency department visits are about $400 per patient.”
Costs increase substantially with the severity of the inpatient visit. “A patient who ultimately goes to the intensive care unit without intubation is about $9000; a patient who goes to the intensive care unit with intubation is about $28,000. A lot of that is based on the intensity of care as well as length of stay, because length of stay goes up as the severity levels go up. So, standard inpatient stay is about 3.5 days. But a patient who goes to the intensive care unit with intubation, they’re in the hospital about 12 days,” Dr Stanford said.
Considering the high costs of hospitalization associated with asthma, a continuum of care aimed at appropriate asthma management could result in substantial cost-savings by reducing the need for hospital utilization.