The economic burden of asthma in US children: Estimates from the National Medical Expenditure Survey

Abstract

Background: Asthma is the leading chronic illness of childhood, is responsible for substantial pediatric morbidity, and has a significant impact on use of health resources. Objective: Our purpose was to assess the per capita impact of pediatric asthma on medical care utilization and total expenditures. Methods: A population-based national probability survey, the National Medical Expenditure Survey, was conducted in 1987 to determine the use and cost of health care services in the United States. We analyzed the responses for all children aged 1 to 17 years with (n = 667) and without (n = 6911) asthma. Children with asthma were identified with use of a population-based screening question. Frequency and cost of medications, ambulatory visits, emergency department care, and hospitalizations for all reasons, including asthma, were assessed. Results: The period prevalence of childhood asthma in 1987 was 8.8% and the treated prevalence (any asthma medications) was 4.0%. Forty-one percent of families with asthmatic children were classified as having no primary insurance. Children with asthma used substantially more services in all categories of care: 3.1 times as many prescriptions, 1.9 times as many ambulatory provider visits, 2.2 times as many emergency department visits, and 3.5 times as many hospitalizations. Only 10.7% of children with asthma were defined as chronic users of medications. Children with asthma incurred an average of $1129 (SD $5310) per child per year in total health care expenditures compared with $468 (SD $2960) for children without asthma, a 2.8-fold difference. Conclusion: Asthma has considerable impact on the use and costs of medical care services among US children. Data from the 1987 National Medical Expenditure Survey provide a useful baseline against which more recent, postguideline data should be compared. (J Allergy Clin Immunol 1999;104:957-63.)