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On May 22, 2008, Rosanna Coffey presented the AHRQ Asthma Return-on-Investment (ROI) Calculator . This is the text version of the event's slide presentation. Please select the following link to
access the slides: (PowerPoint® file, 851 KB).
Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29
Slide 1: The Asthma Care Return-on-Investment Calculator: How to use it
The Asthma Care Return-on-Investment Calculator: How to use it
Ginger Smith Carls, M.A. and Rosanna Coffey, Ph.D.
Thomson Reuters (formerly Medstat)
May 22, 2008
On the top of the slide are the logos for the Department of Health & Human Services and the Agency for Healthcare Research and Quality (AHRQ).
This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left.
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Slide 2: Outline
Outline
This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left.
- Brief review of calculator
- How to use the calculator
- Data
- Interpretation of results
- Limitations and solutions
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Slide 3: Review of the Calculator
Review
of the Calculator.
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Slide 4: Purpose
- To help policy makers (States) with program design for asthma care quality improvement
- To estimate financial return based on evidence
- To summarize a large literature (52 studies)
- To translate utilization-based results into costs
- To summarize impacts based on user interests
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Slide 5: Methods
The sum of Evidence of Utilization Impact and Cost Data is Financial Impact.
- Definitions: Asthma care programs typically follow NAEPP (National Asthma Education and Prevention Program) guidelines
- Patient education
- Provider activities
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Slide 6: How to use the calculator: Data
How to use the calculator: Data.
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Slide 7: Data needed: Overview
- Number of eligible asthma patients
- Baseline utilization and costs
- Evidence
- Cost to implement the program
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Slide 8: Data needed: Eligible asthma patients
Options:
A. Calculate number eligible using own data (i.e. medical claims)
or
B. Use calculator to estimate eligible patients
More details:
A. Calculate number eligible using own data (i.e. medical claims)
- Define criteria for eligible asthma patients. Example:
- Patients with at least one asthma diagnosis
- Patients with persistent asthma
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Slide 9: Data needed: Eligible asthma patients
B. Use calculator to estimate eligible asthma patients
Data Fields
- Percent of enrollees in each age/gender cell
- Percent enrollees of each race/ethnicity
- Total number of enrollees
Options
- Asthma severity
- Type of health coverage (Medicaid or employer-sponsored)
How calculator estimates eligible patients:
- Asthma prevalence rates come from MarketScanTM, Medicaid, or Commercial Claims databases
- Prevalence rates are adjusted by all of the demographic and asthma severity information entered by user, based on evidence from MarketScan TM
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Slide 10: Data needed: Baseline
Baseline = the use and cost patterns of program participants before the asthma care program
Data Fields
- Use
- Emergency department visits per patient per year
- Hospital stays per patient per year
- Outpatient visits per patient per year
- Cost (payment amount)
- Emergency department cost per visit
- Hospital cost per stay
- Outpatient cost per visit
- Asthma medication cost per patient per year
- Asthma-related ancillary service (lab, imaging, etc.) cost per patient
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Slide 11: Data needed: Baseline
Data Fields (continued)
- Missed work or school (optional)
- Number of missed work or school days per patient per year
- Cost of a missed work or school day
- Advice for calculating data fields:
- Decide what use & cost components to include
- It's okay to combine use & cost from different sources
- Just make sure measures are calculated the same way for the same population
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Slide 12: Data needed: Baseline
Source of default data:
MarketScan Claims Database (2005)
- Medicaid
- 8 states
- Geographically dispersed
- Employer-sponsored health insurance
- Over 100 large self-insured employers
- Over 15 million lives
- Geographically balanced
National Health Interview Survey (2003)
- Number of missed work or school days due to asthma
- U.S. estimate
Bureau of Labor Statistics (2006)
- Average wage rate
- Federal poverty line (for value of missed work day for Medicaid recipients)
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Slide 13: Data needed: Evidence
Data Fields
Average annual percent change in:
- Number of asthma-related hospital stays
- Number of asthma-related ER visits
- Number of asthma-related outpatient visits
- Payments for outpatient prescription drugs
- Payments for asthma-related ancillary services
- Number of missed work days (optional)
- Number of missed school days (optional)
Where to find these data:
- Results from our meta-analysis of the literature is in the calculator
- You may enter these if you have results from a pilot study
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Slide 14: Data needed: Evidence
Example calculation of percent change in visits
| |
Rate at baseline (Before) |
Rate at end (After) |
| Treatment Group |
A=10 |
B=5 |
| Control Group |
C=10 |
D=8 |
- No control group : (B - A )/A*100 = - 50%
- Randomized controlled study: (B - D)/D*100 = - 38%
- Statistically controlled study:
Percent change in treatment - percent change in control = (B-A)/A*100 - (D-C)/C*100 = - 50 - (- 20) = - 30%
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Slide 15: Data needed: Evidence in calculator
Type of visit, by age groups included.
| |
Children only
(Total Patients) |
Children only
(Number of Studies) |
Adults Only
(Total Patients) |
Adults Only
(Number of Studies) |
Both children and adults
(Total Patients) |
Both children and adults
(Number of Studies) |
Total
(Total Patients) |
Total
(Number of Studies) |
| ED visits |
13,213 |
21 |
714 |
11 |
8,812 |
9 |
22,739 |
40 |
| Hospitalizations |
17,575 |
19 |
7,161 |
9 |
2,526 |
7 |
27,262 |
33 |
| Outpatient visits |
20,229 |
18 |
6,986 |
4 |
1,888 |
5 |
29,103 |
25 |
| Missed work/ school days |
4,172 |
11 |
521 |
5 |
443 |
3 |
5,136 |
17 |
| Medication Cost |
486 |
2 |
301 |
3 |
13,580 |
5 |
14,367 |
10 |
| Ancillary service cost |
61 |
1 |
148 |
2 |
0 |
0 |
209 |
3 |
Notes: Total studies can be less than the sum of the columns because some studies reported results separately for adults and children.
Total patients includes both treatment and control patients.
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Slide 16: Data needed: Program cost and design
Data fields
- Annual cost per participant
- Number of years until full impact (i.e. program "ramp-up")
- Discount rate
- Duration of program
Questions to consider
- How to choose a discount rate?
- How to estimate annual cost per participant?
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Slide 17: Data needed: Wrap-up
- Types of data needed
- Number of eligible asthma patients
- Baseline utilization and costs
- Evidence
- Program cost and design
- Putting it all together
- Ideally, find data from a single source
- If not possible, be sure that the underlying populations that generated the data are similar
- Use claims data to obtain number of eligible asthma patients and their baseline utilization and costs
- Find evidence that studied a similar population
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Slide 18: Data needed: Discussion
- Ideas for data sources?
- Evidence
- Number of eligible asthma patients
- Baseline utilization and cost
- Program cost
- What technical assistance do you need from AHRQ to find data?
- Questions?
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Slide 19: How to use the calculator
Interpretation of results
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Slide 20: Example results
Example results
- Results from default data
- Nationwide
- Program lasts for 5 years
- Takes 2 years to ramp up
- Discount rate is 3%
- Evidence from randomized controlled studies
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Slide 21: Results using default data
| Options (Not all options are shown) |
(1) |
(2) |
(3) |
(4) |
| Type of Insurance |
Medicaid |
Medicaid |
Medicaid |
Employer sponsored |
| Age Groups |
Adults and children |
Children |
Children |
Children |
| Asthma Severity |
Persistent asthma |
Persistent asthma |
Persistent asthma |
Persistent asthma |
| Annual Program Cost |
$395 |
$395 |
$100 |
$100 |
| Medical costs included |
All payments |
All payments |
All payments |
All payments |
| Productivity costs included |
No |
No |
No |
No |
| Number of eligible patients with asthma (nationwide) |
1.97 million |
850 thousand |
850 thousand |
1 million |
| Results |
| Net Present value (per participant) |
($1,552) |
($1,228) |
$123 |
($60) |
| ROI |
$0.14 |
$0.32 |
$1.27 |
$0.87 |
| Break Even Program Cost |
$56.04 |
$126.76 |
$126.76 |
$86.97 |
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Slide 22: Results using default data
| Options (Not all options are shown) |
(5) |
(6) |
(7) |
(8) |
| Type of Insurance |
Employer sponsored |
Employer sponsored |
Employer sponsored |
Employer sponsored |
| Age Groups |
Children |
Children |
Adults |
Adults |
| Asthma Severity |
Persistent asthma with acute visits |
Persistent asthma with acute visits |
Persistent asthma |
Persistent asthma |
| Annual Program Cost |
$100 |
$100 |
$100 |
$100 |
| Medical costs included |
All payments |
Only plan costs |
Only plan costs |
Only plan costs |
| Productivity costs included |
No |
No |
No |
Yes |
| Number of eligible patients with asthma (nationwide) |
200 thousand |
200 thousand |
2.2 million |
2.2 million |
| Results |
| Net Present value (per participant) |
$822 |
$561 |
($812) |
$2,264 |
| ROI |
$2.80 |
$2.22 |
$0.77) |
$5.94 |
| Break Even Program Cost |
$279.54 |
$222.39 |
($77.30) |
$594.44 |
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Slide 23: How to use calculator
- Forecast financial impact
- Assess impact of key assumptions about proposed program
- Examine alternative types of programs to assess tradeoffs
- Are assumptions "reasonable" compared to other evidence?
- Estimate "cost hurdle" needed to break-even
- Observe components of calculator in planning an evaluation of an asthma care program
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Slide 24: Uses: How it helps with policy
- Michigan Pediatric Asthma Coalition: Funding decision for a county asthma program
- New York Department of Health: Evaluation components for a housing improvement project that should reduce asthma symptoms
- Iowa Medicaid Medical Officer: Considering value of asthma care improvements for Medicaid
At the bottom of the slide is an arrow pointing from graphics of literature toward money.
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Slide 25: Limitations and possible solutions
Limitations and possible solutions.
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Slide 26: Caveats
- Limited evidence for some components:
- Few studies (7) reported program cost - wide range:
- Average = $395 dollars per patient per year
- Min = $81 automated general educational mailing
- Max = $989 program for highest cost patients
- Few studies (10) reported asthma medication costs:
- Studies without a control group reported larger increases in medication
costs
- Baseline asthma medication costs varied
- AHRQ does not plan updates at this time
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Slide 27: Caveats & Solutions
Problems:
- Literature continues to grow
- Baseline data becomes obsolete
- Cost estimates are for 2006
Solutions for users:
- Monitor literature post April 2007 & input results
- Use your own data to populate the calculator
- Inflate findings beyond 2006, using the CPI-M
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Slide 28: Discussion
- Other limitations, concerns?
- Ways the calculator could be made more useful?
- Questions about interpretation of results?
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Slide 29: Additional assistance:
Technical Assistance:
•Margie Shofer, Marjorie.Shofer@ahrq.hhs.gov
Senior Program Analyst, Office of Communications and Knowledge Transfer
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