Asthma-Related Costs Relative to Severity and Control in General Practice

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Abstract
Limited data are available about costs of asthma care by general practitioners (GPs) in France. This study evaluated asthma care costs of children treated by GPs, and the relationship between cost and asthma control across different degrees of asthma severity. We conducted a retrospective longitudinal observational study based on a computerized prescription database of GPs supplemented with a cross-sectional survey of children aged 6–16 with persistent asthma (GINA step ≥2). Retrospective data on asthma-related medical resource utilization (MRU) were collected for a 12-month study period. MRU included antiasthma medications, visits to GPs, visits to emergency rooms, and hospitalizations. Asthma control was evaluated from recent asthma symptoms, whereas severity was defined by the average dose of inhaled corticosteroids prescribed during a preindex period. Univariate and multivariate analyses were used to evaluate relationships between MRU and other variables of interest. Among 261 children with completed surveys, the proportion of total MRU cost due to GP visits, medications, and emergency room visits was 20%, 30%, and 2%, respectively. Although hospitalizations accounted for almost 50% of total costs, only 17 children (6.5%) were hospitalized during the study period. In children with severe asthma, total MRU cost was significantly higher when control of asthma was poor, compared with moderate and good levels of asthma control (p = 0.004). However, no similar association emerged in children with low and moderate severity. A minority of children with high-cost medical use accounted for a significant part of total expenditures. Total MRU costs varied according to level of control in children with high disease severity. (Pediatr Asthma Allergy Immunol 2005; 18[1]:36–45.)