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

J Allergy Clin Immunol. 2005 Nov;116(5):1058-63. doi: 10.1016/j.jaci.2005.07.032. Epub 2005 Oct 3.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Air Pollution, Indoor / adverse effects*
  • Air Pollution, Indoor / prevention & control*
  • Asthma / etiology*
  • Asthma / physiopathology
  • Asthma / therapy*
  • Child
  • Cost-Benefit Analysis
  • Health Care Costs*
  • Health Services / statistics & numerical data
  • Humans
  • Poverty Areas*
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Urban Population*