Investigators from Brown University and the University of California, Berkeley sought to determine the financial return on investment (ROI) of the Parents of Asthmatics Quit Smoking (PAQS) program. PAQS is a program for caregivers who are smokers and have a child with asthma. As part of the program, nurses provide asthma education and smoking cessation counseling in 3 home visits. Investigators calculated the ROI by analyzing claims data 12 months pre-enrollment and post-completion of the intervention in a subsample of PAQS participants who were on a Medicaid managed care plan. Total billable costs (TBC) were determined by summing the costs of short-acting β-agonists, controller medications, emergency department (ED) visits, hospitalizations, and outpatient visits for asthma. The cost of delivering the PAQS intervention was calculated by summing direct expenditures, start-up costs, and elements of overhead. The primary outcome was ROI, calculated as ([TBC pre-PAQS – TBC post-PAQS] – Intervention Costs) / Intervention Costs, for the total sample and for 3 subgroups (children <6 years old, children 6-18 years old, and children with moderate to severe persistent asthma).
The analysis included 224 PAQS participant children. The cost of the PAQS intervention in this sample was $34,481. Postintervention, there was a significant increase in mean annual fills for β-agonist and controller medications and a corresponding increase in medication costs per participant. However, there was also a significant decrease in health care utilization including emergency room visits, hospitalizations, and outpatient visits postintervention. The ROI for the total sample was –21.8%. However, for children <6 years old it was 106.9%, and for children with moderate to severe persistent asthma, it was 6.9%. The ROI was –150.3% for children 6 to 18 years old.
The authors conclude that while the overall ROI of PAQS was negative, PAQS yielded a highly positive ROI for children <6 years old.
Adverse effects of tobacco smoke exposure on children’s health have been well documented.1 There has been a steady increase in the number of studies showing an association of environmental tobacco smoke (ETS) exposure and asthma. As a result, the Expert Panel Report-3 (EPR-3) 2007 Asthma Guidelines, citing this supporting evidence,2 published a longer statement regarding education on smoking cessation compared to EPR-2 (1997, revised in 2002).3 EPR-3 recommends assessing ETS exposure in the household and referring parents and caretakers who smoke to smoking cessation programs.
A study prior to PAQS showed that reduced ETS exposure to asthmatic children in an urban setting was associated with a decrease in asthma-related exacerbations.4 Consequently, there has been substantial effort to develop effective asthma education and smoking cessation programs. A home-based educational program model is costly compared to the standard education given at patient encounters, yet these programs offer the benefit of reaching out to caregivers who...