The Cost of Combining Asthma and Bronchiolitis Diagnoses in Hospitalized Children

Combined diagnoses of bronchiolitis and asthma can create challenges in de-implementation in accordance with guidelines aiming to reduce low value care. We sought to quantify the cost and resource utilization associated with combined diagnoses of asthma and bronchiolitis in young children, hypothesizing that combined diagnoses are associated with increased cost.

This was a retrospective cohort study of respiratory hospitalizations of children under 36 months of age in the Pediatric Health Information System during 2023-2024. Encounters were identified by ICD-10 codes and grouped according to a diagnosis of bronchiolitis, asthma, or combined diagnoses. Comparisons between standardized unit costs for the three groups were made using generalized estimating equations adjusting for important clinical and demographic characteristics.

We identified 80368 hospital encounters with 13.0% of patients receiving a diagnosis of asthma alone, 74.6% with bronchiolitis alone, and 12.4% with combined diagnoses. Adjusted costs for combined diagnoses were 16% higher than asthma ($754 per admission) and 13% higher than bronchiolitis ($647 per admission). When compared to asthma, primary drivers of increased costs for combined diagnoses were room and board (RR 1.2, 95% CI 1.17-1.24, $719). When compared to bronchiolitis, drivers of increased costs for combined diagnoses included clinical (RR 3.2, 95% CI 2.15-4.77, $266) and pharmacy charges (RR 3.64, 95% CI 2.7-4.9 $52).

We identified higher costs associated with combined diagnoses. These findings suggest that focusing on diagnostic specificity may be a viable target for deimplementation efforts.