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Published on: November 5, 2010
Health care utilization and cost in children with asthma and selected comorbidities
J Grupp-Phelan1, P Lozano, P Fishman
1Department of Pediatrics, University of Washington School of Medicine, Seattle, USA. grupj0@chmcc.org
Insights
Children with asthma incur higher healthcare costs, often due to related upper respiratory conditions like allergic rhinitis. Managing these comorbidities is key to reducing overall healthcare utilization and expenses for pediatric asthma patients.
Area of Science:
- Pediatric Healthcare
- Respiratory Medicine
- Health Services Research
Background:
- Children with asthma utilize more healthcare services than their peers.
- A significant portion of healthcare costs for asthmatic children are for non-asthma related services.
- Upper respiratory comorbidities are common in children with asthma.
Purpose of the Study:
- To quantify the impact of asthma and specific upper respiratory comorbidities on healthcare utilization and costs in children.
- To identify the relationship between conditions like otitis media, sinusitis, and allergic rhinitis and asthma diagnosis.
- To analyze the contribution of comorbidities to the overall healthcare burden in pediatric asthma.
Main Methods:
- Population-based historical cohort study (1992-1992) of 71,818 children aged 1-17 years.
- Defined multiple visits for otitis media, sinusitis, and allergic rhinitis as comorbidities.
- Measured outcomes including nonurgent outpatient care, pharmacy fills, urgent care visits, hospital care, and total costs.
Main Results:
- Children with asthma were more likely to have a comorbidity (26% vs. 9%).
- Asthma diagnosis was significantly associated with multiple visits for otitis media (1.8x), sinusitis (4x), and allergic rhinitis (12x).
- Children with asthma had a higher probability (47%) of being in the highest total cost quintile, even after adjusting for comorbidities.
Conclusions:
- Visits for otitis media, sinusitis, and especially allergic rhinitis are overrepresented in children with asthma.
- These comorbidities significantly contribute to the high healthcare utilization rates observed in pediatric asthma.
- Targeted care management strategies for high-risk children with asthma and comorbidities are recommended to optimize healthcare delivery and reduce costs.
Abstract:
Children with asthma use significantly more health services than other children, yet the majority of their health care costs are for nonasthma services. The objective of this study was to measure the impact of asthma and specific upper respiratory comorbidities on the use and cost of health care by children. A population-based historical cohort study from January 1, 1992 to December 31, 1992 was conducted. Multiple visits for otitis media, sinusitis, and allergic rhinitis were considered comorbidities. The outcome measures were nonurgent outpatient care, pharmacy fills, urgent care visits, and hospital care along with the associated total costs. Children between ages 1 and 17 years were studied (n = 71,818). Children with asthma were more likely than children without asthma to have a comorbidity (26% vs. 9%). Children with multiple visits for otitis media, sinusitis, and allergic rhinitis were 1.8, 4, and 12 times more likely, respectively, to have a diagnosis of asthma in the same year. Children with asthma had a 47% probability of being in the highest total cost quintile compared to a 29% likelihood once adjusted for comorbidities. Visits for otitis media, sinusitis, and particularly allergic rhinitis appear to be overrepresented in children with asthma and contribute to their high utilization rate. Once a high-risk cohort is identified, the needs of those children can be addressed through targeted, organized systems of care that may include guidelines or other disease management strategies.
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