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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Stempel DA et al; "The Economic Impact of Children Dispensed Asthma Medications Without an Asthma Diagnosis." Journal of Pediatrics; V.148; 6/06; p819
      STUDY DESIGN: The prevalence of childhood asthma in the United States has been reported to range from 6% to 18%. The lack of a gold standard for the diagnosis of pediatric asthma contributes to the variability in rates of childhood asthma. In an effort to overcome the differences in methodology of previous prevalence studies, the International Study of Asthma Allergies in Childhood (ISAAC) was designed to determine the prevalence of childhood asthma by using a standardized and validated methodology. ISAAC has been used in more than 50 countries and more than 100 independent sites. The current study was designed to compare the resource utilization and healthcare costs of children with a diagnosis of asthma, children dispensed asthma medications but without a diagnosis of asthma, and control children. This study was a descriptive, retrospective, cross-sectional analysis conducted during the calendar year of 2001. Patients were identified from an integrated managed-care database (PharMetrics; Watertown, MA), which is a collection of administrative claims from a number of managed-care organizations distributed across the United States. A total of 295,099 children were identified.
      ASTHMA TREATMENT WITHOUT AN ASTHMA DIAGNOSIS: Overall, an asthma diagnosis (Dx cohort) was recorded in 6.7% of the population, and 4.4% of the children met the criteria for the asthma Rx cohort (prescription for an asthma controller or reliever medication but without an asthma diagnosis) during the study year. The prevalence of physician-diagnosed asthma (Dx cohort) was highest in the 2- to 4-year-olds (7.9%) and lowest in the 13- to 17-year-olds (5.5%). A significant male predominance was noted in the overall Dx and Rx cohorts compared with the control children.
      13% and 12% of the 0- to 1-year-olds and 2- to 4-year-olds, respectively, met either the Rx or Dx criteria for asthma compared with 11.2% and 10.1% of the 5- to 12- and 13- to 17-year-olds, respectively. The relative proportion of children identified with asthma by the Rx criteria versus the Dx criteria was greatest in the oldest age group.
      COST DATA: The mean total asthma-related costs, which were based on asthma-specific medical and pharmacy claims in the Dx cohort but only pharmacy claims in the Rx cohort, were significantly higher in the Dx cohort ($389) than the Rx cohort ($70). The mean total nonasthma costs were 2-fold higher in the Dx ($1642) and 1.6-fold higher in the Rx ($1306) cohorts compared with the control children ($802). The mean total all-cause costs, the sum of asthma-related, and nonasthma costs were also significantly higher in the Dx ($2031) and Rx ($1376) cohorts compared with control children ($802). Asthma-related costs comprised 19% of total all-cause costs in the Dx cohort and 5% of total costs in the Rx cohort.
      EMERGENCY DEPARTMENT AND HOSPITAL USE: Emergency department visits and/or hospitalizations associated with an asthma claim occurred in 11% of the Dx cohort.
      MEDICATION USE: Short-acting beta-agonists (SABAs) were used by 57% of the Dx cohort and 89% of the Rx cohort. A total of 34.8% and 28.6% of patients in the Dx and Rx cohorts, respectively, had a claim for a controller medication. Oral corticosteroids (OCSs) were dispensed for 3% of the control children, 17% of the Rx cohort, and 30% of the Dx cohort. Nearly 90% of children in the Rx cohort were dispensed a SABA and 17% were dispensed an OCS, and yet none of these patients had a diagnosis of asthma. Although some of the SABA utilization may have been as a therapeutic trial, the high rate of OCS utilization suggests that a significant proportion of these children had episodes of acute severe asthma.
      DISCUSSION: An important finding of the present study is the association of OCS use and asthma. Children in the Dx and Rx cohorts had a 13.9-fold and 6.7-fold greater risk, respectively, of using an OCS compared with control children.
      The accurate diagnosis of asthma is an important component of asthma management that is emphasized in national and international treatment guidelines. Proper identification of childhood asthma is the initial requirement for proper treatment. The results of this study suggest that undiagnosed children who use asthma medications require more recognition from clinicians and potentially better treatment.

Search Criteria: Text - Journal of Pediatrics; V.148; 6/06; p819