The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Pages 1058-1063, November 2005

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

  • Meyer Kattan, MD, CM

      Affiliations

    • From the Department of Pediatrics, Mount Sinai School of Medicine, New York
    • Corresponding Author InformationReprint requests: Meyer Kattan, MD, Department of Pediatrics, Mount Sinai School of Medicine, Box 1202B, One Gustave L. Levy Place, New York, NY 10029.
    • ,
  • Sally C. Stearns, PhD

      Affiliations

    • Department of Health Policy and Administration, University of North Carolina at Chapel Hill
    • ,
  • Ellen F. Crain, MD, PhD

      Affiliations

    • Department of Pediatrics (Emergency Medicine), Albert Einstein College of Medicine/Jacobi Medical Center, Bronx
    • ,
  • James W. Stout, MD, MPH

      Affiliations

    • Department of Pediatrics, University of Washington School of Medicine, Seattle
    • ,
  • Peter J. Gergen, MD

      Affiliations

    • Asthma, Allergy, Inflammation Branch, Division of Allergy, Immunology, Transplantation, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda
    • ,
  • Richard Evans III, MD, MPH

      Affiliations

    • Departments of Pediatrics and Medicine, Northwestern University Medical School, Chicago
    • ,
  • Cynthia M. Visness, MA, MPH

      Affiliations

    • Rho, Inc, Chapel Hill
    • ,
  • Rebecca S. Gruchalla, MD, PhD

      Affiliations

    • Departments of Medicine and Pediatrics, University of Texas Southwestern Medical Center at Dallas
    • ,
  • Wayne J. Morgan, MD, CM

      Affiliations

    • Respiratory Sciences Center, University of Arizona College of Medicine, Tucson
    • ,
  • George T. O'Connor, MD, MS

      Affiliations

    • Boston University School of Medicine
    • ,
  • J. Patrick Mastin, PhD

      Affiliations

    • National Institute of Environmental Health Sciences, Research Triangle Park
    • ,
  • Herman E. Mitchell, PhD

      Affiliations

    • Rho, Inc, Chapel Hill

Received 14 April 2005; received in revised form 12 July 2005; accepted 26 July 2005. published online 04 October 2005.

New York and Bronx, NY, Chapel Hill and Research Triangle Park, NC, Seattle, Wash, Bethesda, Md, Chicago, Ill, Dallas, Tex, Tucson, Ariz, and Boston, Mass

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.

Key words: Asthma, inner city, cost-effectiveness, asthma intervention, allergen mitigation

Abbreviations used: EC, Environmental counselor, HEPA, High-efficiency particulate air (filter), ICAS, Inner-City Asthma Study, ICER, Incremental cost-effectiveness ratio, NCICAS, National Cooperative Inner-City Asthma Study, SFD, Symptom-free day

 

 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.

PII: S0091-6749(05)01790-2

doi:10.1016/j.jaci.2005.07.032

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Pages 1058-1063, November 2005

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