Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma.
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 beta-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.
Kattan
Meyer
M
Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA. meyer.kattan@mssn.edu
Stearns
Sally C
SC
Crain
Ellen F
EF
Stout
James W
JW
Gergen
Peter J
PJ
Evans
Richard
R
Visness
Cynthia M
CM
Gruchalla
Rebecca S
RS
Morgan
Wayne J
WJ
O'Connor
George T
GT
Mastin
J Patrick
JP
Mitchell
Herman E
HE
D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000517:prevention & control*; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D011204:Poverty Areas; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D014505:Urban Population