Health care utilization and cost in children with asthma and selected comorbidities

Children with asthma use significantly more health services than other chil dren, yet the majority of their health care costs are for nonasthma service s. The objective of this study was to measure the impact of asthma and spec ific upper respiratory comorbidities on the use and cost of health care by children. A population-based historical cohort study from January 1, 1992 t o December 31, 1992 was conducted. Multiple visits for otitis media, sinusi tis, and allergic rhinitis were considered comorbidities. The outcome measu res 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 l ikely than children without asthma to have a comorbidity (26% vs. 9%). Chil dren with multiple visits for otitis media, sinusitis, and allergic rhiniti s were 1.8, 4, and 12 times more likely respectively, to have a diagnosis o f asthma in the same year Children with asthma had a 47% probability of bei ng in the highest total cost quintile compared to a 29% likelihood once adj usted for comorbidities. Visits for otitis media, sinusitis, and particular ly allergic rhinitis appear to be overrepresented in children with asthma a nd contribute to their high utilization rate. Once a high-risk cohort is id entified, the needs of those children can be addressed through targeted, or ganized systems of care that may include guidelines or other disease manage ment strategies.