RAND Commissioned Studies

Estimating the Impact of Improving Asthma Treatment: A Review and Synthesis of the Literature

The Merck Childhood Asthma Network (MCAN) commissioned the RAND Corporation to conduct a meta-analysis of the gap between recommended and actual asthma care for children in the United States, and what it would cost to close it.

Variability in how asthma severity, outcomes, utilization and other measures were classified made the gap analysis impossible. However, RAND verified substantial disparities in quality of asthma care for children and the fact that disadvantaged populations appeared to receive lower quality care. The findings also suggested the need for evaluating the economic impact of these gaps and the need for research using standard definitions and outcomes to allow comparison across studies.

These findings were presented at the State of Childhood Asthma and Future Directions Conference and precipitated a priority recommendation for the NIH to standardize asthma outcome definitions and research measures. MCAN successfully encouraged the NIH to explore this recommendation and, as a result, the NIH convened the Asthma Outcomes Workshop in 2010. The workshop’s resulting recommendations were published as a supplement to the Journal of Allergy and Clinical Immunology in March 2012.

Assessing the Business Case for Better Asthma Care

The Merck Childhood Asthma Network (MCAN) commissioned RAND to examine the relationship between adherence to use of recommended controller medications and unscheduled health care utilization (e.g., emergency department visits) for asthma using medical claims records filed with private insurers.

Findings of this study, published in the April 2010 issue of the Journal of Asthma, suggested that savings generated by reducing high-cost events like emergency department visits do not offset the increased payments for maintenance therapy.

In 2009, RAND and MCAN pursued this same research question among children with asthma enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The findings from this study suggest that a business case for disease management interventions that aim to improve adherence to anti-inflammatory drugs cannot be made because of the increased costs of care. RAND authors published the results of this study in the journal Pharmacoeconomics in 2012.