title: Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma.
abstract: 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.
authors.affiliation: Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA. meyer.kattan@mssn.edu
authors.forename: Meyer
authors.initials: M
authors.lastname: Kattan
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
authors.forename: James W
authors.initials: JW
authors.lastname: Stout
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gergen
authors.forename: Richard
authors.initials: R
authors.lastname: Evans
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Visness
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Gruchalla
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.forename: George T
authors.initials: GT
authors.lastname: O'Connor
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Mastin
authors.forename: Herman E
authors.initials: HE
authors.lastname: Mitchell
mesh_terms: 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