title: Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity a community guide systematic review.
abstract: BACKGROUND
  A recent systematic review of home-based, multi-trigger, multicomponent interventions with an environmental focus showed their effectiveness in reducing asthma morbidity among children and adolescents. These interventions included home visits by trained personnel to assess the level of and reduce adverse effects of indoor environmental pollutants, and educate households with an asthma client to reduce exposure to asthma triggers. The purpose of the present review is to identify economic values of these interventions and present ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios, and incremental cost-effectiveness ratios).
  
  
  METHODS
  Using methods previously developed for Guide to Community Preventive Services economic reviews, a systematic review was conducted to evaluate the economic efficiency of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. A total of 1551 studies were identified in the search period (1950 to June 2008), and 13 studies were included in this review. Program costs are reported for all included studies; cost-benefit results for three; and cost-effectiveness results for another three. Information on program cost was provided with varying degrees of completeness: six of the studies did not provide a list of components included in their program cost description (limited cost information), three studies provided a list of program cost components but not a cost per component (partial cost information), and four studies provided both a list of program cost components and costs per component (satisfactory cost information).
  
  
  RESULTS
  Program costs per participant per year ranged from $231-$14,858 (in 2007 U.S.$). The major factors affecting program cost, in addition to completeness, were the level of intensity of environmental remediation (minor, moderate, or major), type of educational component (environmental education or self-management), the professional status of the home visitor, and the frequency of visits by the home visitor. Benefit-cost ratios ranged from 5.3-14.0, implying that for every dollar spent on the intervention, the monetary value of the resulting benefits, such as averted medical costs or averted productivity losses, was $5.30-$14.00 (in 2007 U.S.$). The range in incremental cost-effectiveness ratios was $12-$57 (in 2007 U.S.$) per asthma symptom-free day, which means that these interventions achieved each additional symptom-free day for net costs varying from $12-$57.
  
  
  CONCLUSIONS
  The benefits from home-based, multi-trigger, multicomponent interventions with an environmental focus can match or even exceed their program costs. Based on cost-benefit and cost-effectiveness studies, the results of this review show that these programs provide a good value for dollars spent on the interventions.
authors.affiliation: Air Pollution and Respiratory Health Branch, Division of Health Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia 30341, USA. ten7@cdc.gov
authors.forename: Tursynbek A
authors.initials: TA
authors.lastname: Nurmagambetov
authors.forename: Sarah Beth L
authors.initials: SB
authors.lastname: Barnett
authors.forename: Verughese
authors.initials: V
authors.lastname: Jacob
authors.forename: Sajal K
authors.initials: SK
authors.lastname: Chattopadhyay
authors.forename: David P
authors.initials: DP
authors.lastname: Hopkins
authors.forename: Deidre D
authors.initials: DD
authors.lastname: Crocker
authors.forename: Gema G
authors.initials: GG
authors.lastname: Dumitru
authors.forename: Stella
authors.initials: S
authors.lastname: Kinyota
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D003362:Cost-Benefit Analysis; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control*; D052918:Environmental Restoration and Remediation / Q000191:economics / Q000379:methods; D006699:Home Care Services / Q000191:economics* / Q000458:organization & administration; D006792:House Calls; D006798:Housing; D006801:Humans