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Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma

2005; Elsevier BV; Volume: 116; Issue: 5 Linguagem: Inglês

10.1016/j.jaci.2005.07.032

1097-6825

Meyer Kattan, Sally C. Stearns, Ellen F. Crain, James W. Stout, Peter J. Gergen, Richard Evans, Cynthia M. Visness, Rebecca S. Gruchalla, Wayne J. Morgan, George O'connor, J. Patrick Mastin, Herman Mitchell,

Allergic Rhinitis and Sensitization

BackgroundExposure 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.ObjectiveWe sought to assess the cost-effectiveness of the environmental intervention of the Inner-City Asthma Study.MethodsIncremental 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.ResultsThe 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.ConclusionsA 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. 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. We sought to assess the cost-effectiveness of the environmental intervention of the Inner-City Asthma Study. 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. 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. 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.