The following asthma-related morbidity measures were calculated for each of the three study groups: average rate of scheduled and unscheduled medical care visits, rate of emergency department visits, and frequency and length of inpatient stays. The monetary values of these measures were determined according to recent estimates and national statistics. Daily asthma medication costs were calculated based on physicians prescription records. Costs for traditional patient education were derived from existing reimbursement contracts between paymasters and providers and are on a comparable level nationwide. A sickness fund with a market share of approximately 11% reimburses the additional costs of the IEP depending on frequency of use and performance shown by the patient. For the calculation of incremental costs in the IEP group, it was assumed that reimbursement was secured for all participating patients. www.mycanadianpharmacy.com
Transportation costs were calculated on the basis of public inner-city transport tariffs, assuming that for every medical care visit a round-trip ticket was needed. Patients using the IEP had to bear Internet access costs.
Indirect costs included caregivers loss of workdays due to their child’s asthma. Based on national statistics, the average daily gross earning was determined using the human-capital ap-proach. All unit costs and sources are summarized in Table 1.
In all study groups, the average costs per patient during the 6 months prior to baseline visit were determined (costs at visit 1) and extrapolated to annual costs (costs at visit 1 X 2). In the intervention groups, the average annual costs during the observational period were subtracted from these baseline costs in order to arrive at the morbidity cost savings (savings = [costs at visit 1 X 2] — [costs at visit 2 + costs at visit 3]).
Table 1—Cost Items, Data Sources, and Unit Costs in 2001 Euros
|Cost Items||Data Source||Unit Cost, €|
|GP consultation fee (first/subsequent visit in a quarter)||National catalogue of fees for services; definition of routine services by experts according to Woehl||34.20/23.60|
|Specialist consultation fee (first/subsequent visit in a quarter)||National catalogue of fees for services; definition of routine services by experts according to Woehl||43.40/34.00|
|Hospital day (including allowances granted by official authorities)||Deutsche Krankenhausgesellschaft||346.70|
|Emergency department visit||National catalogue of fees for services; definition of routine services by experts according to Woehl||26.00|
|Ambulance transport in case of emergency||Bavarian Red Cross||461.78|
|Emergency physician answering an emergency call||Bavarian Red Cross||512.78|
|GP answering an emergency call||32.80|
|Traditional patient education||Contract between health-care insurance companies and the national working group of asthma patient education||541.14|
|IEP, additional fee||Contract between Barmer Ersatzkasse (sickness fund) and IEP provider||43.99|
|Medication||Rote Liste||Varies by medication|
|Direct, nonmedical costs|
|Public transport per scheduled or unscheduled visit at GP or specialist||Ministry of Economics, Energy, and Transport||3.10|
|Internet fees (IEP group only) within 6 mo||Deutsche Telekom, IEP provider||14.40|
|Productivity loss per day of absence from work||Statistisches Bundesamt||94.70|