Asthma prevalence, cost, and adherence with expert guidelines on the utilization of health care services and costs in a state Medicaid population

Health Serv Res. 2001 Jun;36(2):357-71.


Objective: To provide a descriptive analysis of asthma prevalence and costs in a Medicaid population and gauge the degree of adherence with expert guidelines for asthma medication management from the National Asthma Education and Prevention Program.

Data sources: Kentucky Medicaid administrative data for 1996.

Study design: A cross-sectional retrospective analysis was used to determine adherence with asthma medication guidelines and utilization of asthma-related health care services and costs. Multivariate logistic regression was used to determine the relationship between nonadherence with the guidelines and utilization of health care services.

Principal findings: Of the 530,000 Medicaid recipients, 24,365 (4.6 percent) were identified as having asthma. Average annual asthma-related costs ($616) accounted for less than 20 percent of total health care costs ($3,645). Nonadherence to the guidelines was prevalent. Less than 40 percent of the patients received a prescription for a rescue medication, and fewer than 10 percent of the patients who received daily inhaled short-acting beta-2 agonists were regular users of inhaled steroids. Nonadherence to the guidelines was associated with an increased risk of an asthma-related hospitalization (odds ratio = 1.5, p < .05).

Conclusions: Guideline nonadherence was widespread and associated with an increase in exacerbations of asthma that resulted in hospitalizations. Asthma prevalence and utilization of health care services in a Medicaid population were similar to previous estimates reported nationally and in health maintenance organizations.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma* / drug therapy
  • Asthma* / economics
  • Asthma* / epidemiology
  • Child
  • Cost-Benefit Analysis
  • Cross-Sectional Studies
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Health Care Costs / statistics & numerical data*
  • Health Services / economics*
  • Health Services / statistics & numerical data*
  • Health Services Research
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Kentucky / epidemiology
  • Logistic Models
  • Male
  • Medicaid / economics
  • Medicaid / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic*
  • Prevalence
  • Retrospective Studies
  • Risk Factors


  • Anti-Asthmatic Agents