Asthma, Rhinitis, Other Respiratory Diseases
The cost-effectiveness of an inner-city asthma intervention for children,☆☆,,★★

https://doi.org/10.1067/mai.2002.128009Get rights and content

Abstract

Background: Comprehensive management efforts to reduce asthma morbidity among children in urban areas with high levels of poverty and large minority populations have been inconclusive. The National Cooperative Inner-City Asthma Study (NCICAS) demonstrated improved symptom outcomes but did not evaluate cost-effectiveness in this population. Objective: We sought to examine the incremental cost-effect-iveness of a comprehensive social worker–based education program and environmental control in children with asthma stratified by baseline level of asthma control. Methods: We performed a prospective cost-effectiveness analysis alongside a randomized trial. A total of 1033 children and their families residing in 8 inner-city urban areas in the United States were enrolled in the NCICAS. Outcomes included symptom-free days, cost per symptom-free day gained, and annual costs of asthma morbidity compared by baseline symptom control, previous hospitalization, and previous unscheduled physician visits. Results: The NCICAS intervention significantly reduced asthma symptoms. First-year intervention costs were $245 higher for the intervention children compared with those receiving usual care. There were no additional intervention-related costs during the second year. When compared with usual care, the intervention improved outcomes at an average additional cost of $9.20 per symptom-free day gained (95% CI, −$12.56 to $55.29). The intervention was cost saving in 3 strata of children with increasing asthma severity. Conclusions: A multifaceted asthma intervention program reduced symptom days and was cost-effective for inner-city children with asthma. In children with more severe disease, the intervention was substantially more effective and reduced costs compared with that seen in control children. Organizations serving this population should consider this strategy as part of a comprehensive disease-management program for asthma. (J Allergy Clin Immunol 2002;110:576-81.)

Section snippets

Methods

A cost-effectiveness evaluation of the NCICAS multicenter randomized trial was conducted by using a Medicaid payer perspective because the majority of children in the clinical trial were either recipients or eligible for Medicaid coverage. Outcomes, costs, and cost-effectiveness were analyzed over a 2-year period in accordance with the methodology principles for conducting economic evaluations outlined by the US Public Health Services panel on cost-effect-iveness in health and medicine.15

The

Results

Baseline characteristics of the children are shown in Table I.

. Comparison of baseline characteristics of the AC intervention and usual care groups

Empty CellUsual care group (n = 518)AC intervention group (n = 515)
Male sex, %66.062.1
Age, y (mean ± SD)7.6 ± 1.87.7 ± 1.9
Race-ethnicity, %
Black73.175.9
Hispanic17.417.1
Other9.57
Had primary care physician, %79.384.7
Household income <$15,000/y, %66.068.9
Maximum symptom days (per 2 wk)5.1 ± 4.65.1 ± 4.5
≥1 hospitalization in past 2 mo, %3.95.0

No between-group

Discussion

Asthma morbidity remains a significant public health concern, especially in children living in the dense, urban areas of the United States. Randomized trials have now shown that educational and self-management efforts targeted toward these high-risk children can be effective. However, the cost-effectiveness of these programs had not previously been evaluated. Despite this, more resources continue to be directed toward families and children living in these settings.

We found that when compared

Acknowledgements

We thank Kristin Marciante, MPH, of the University of Washington for data analysis support.

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    *A list of National Cooperative Inner-City Asthma Study, Phase II, investigators can be found in the Appendix.

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    Supported by the National Institute of Allergy and Infectious Disease grants U01 A1-30751, A1-30752, A1-30756, A1-30772, A1-30773-01, A1-30777, A1-30779, A1-30780, and N01 A1-15105 and a research grant to the University of Washington from GlaxoSmithKline.

    This article does not represent the policy of the Agency for Healthcare Research and Quality. The views expressed are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the National Institutes of Health is intended or should be inferred.

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    Reprint requests: Sean D. Sullivan, PhD, Departments of Pharmacy and Health Services, Box 357630, University of Washington, Seattle, WA 98195.

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