Health care education, delivery, and quality
Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma

https://doi.org/10.1016/j.jaci.2005.07.032Get rights and content

Background

Exposure to indoor allergens contributes to increased asthma morbidity. The Inner-City Asthma Study, a randomized trial involving home environmental allergen and irritant remediation among children aged 6 through 11 years with moderate-to-severe asthma, successfully reduced asthma symptoms. A cost-effectiveness analysis can help stakeholders to evaluate the potential costs and benefits of adopting such a program.

Objective

We sought to assess the cost-effectiveness of the environmental intervention of the Inner-City Asthma Study.

Methods

Incremental cost-effectiveness ratios for a 2-year study period were calculated. Health outcome was measured as symptom-free days. Resource use measures included ambulatory visits, hospitalizations, and pharmaceutical use. CIs were obtained by using bootstrapping.

Results

The intervention, which cost $1469 per family, led to statistically significant reductions in symptom days, unscheduled clinic visits, and use of β-agonist inhalers. Over the year of the intervention and a year of follow-up, the intervention cost was $27.57 per additional symptom-free day (95% CI, $7.46-$67.42). Subgroup analysis showed that targeting the intervention to selected high-risk subgroups did not reduce the incremental cost-effectiveness ratio.

Conclusions

A targeted home-based environmental intervention improved health and reduced service use in inner-city children with moderate-to-severe asthma. The intervention is cost-effective when the aim is to reduce asthma symptom days and the associated costs.

Section snippets

Methods

Full details of the ICAS environmental intervention and outcome have been published previously.4, 5 The study was undertaken at 7 urban locations across the United States (Boston, Mass; Bronx, NY; Chicago, Ill; Dallas, Tex; New York, NY; Seattle, Wash; and Tucson, Ariz). Children aged 5 to 11 years who were diagnosed with asthma by a physician and had at least 1 positive skin test response to an indoor allergen were enrolled. Additional inclusion criteria were that the child had to have at

Results

A full assessment of the effect of the intervention on the child's asthma symptoms and pulmonary function and on the caretaker (eg, losing sleep or changing plans) has been published.4 Measures of average annual health service use over the 2-year study period are provided in Table II. The intervention reduced the number of unscheduled clinic visits by 0.24 per year (a 19% reduction relative to the control group) and reduced the number of β-agonist inhalers used per year by 0.86 (a 13%

Discussion

The ICAS home-based environmental intervention resulted in clinically significant improvement in health status and reductions in resource use among inner-city children with moderate-to-severe asthma. Over the 2 years of cost assessment, which included a year of intervention and a second year of follow-up only, the intervention cost was $27.57 per SFD gained. This study was carried out at 7 sites across the United States, making the findings generalizable to other inner-city populations in which

References (14)

There are more references available in the full text version of this article.

Cited by (0)

Supported by grants AI-39769, AI-39900, AI-39902, AI-39789, AI-39901, AI-39761, AI-39785, and AI-39776 from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, DHHS, and the National Institute of Environmental Health Sciences, National Institutes of Health, DHHS.

Disclosure of potential conflict of interest: R. Gruchalla has consultant arrangements with the GSK Allergy Fellowship Grant Review Board; receives grants from the National Institutes of Health, ExxonMobil, and Foundation support; and is employed by the US Food and Drug Administration. M. Kattan is on the speakers' bureau for Astra-Zeneca. W. Morgan has consultant arrangements with Genentech Inc. All other authors—none disclosed.

View full text