Asthma home intervention cost-effective for inner-city children, research reveals

10/25/05

CHAPEL HILL – Through efforts to limit exposure to environmental irritants, health workers and municipalities can cut illness generally among inner-city children with asthma and also the number of clinic visits for those young patients by at least 19 percent, a new study concludes. The cost can be as low as $1,469 per affected family.

Last year, researchers reported in the New England Journal of Medicine that an intervention designed to reduce exposures of children with asthma to irritants and allergens at home succeeded in partially curtailing disruptive and sometimes life-threatening symptoms.

The latest part of the multi-center study evaluated the cost-effectiveness of those home-based efforts, which included buying impermeable mattress and pillow covers for each child. It showed that the statistically significant reductions in sickness and associated health-care use substantially offset the intervention's cost.

Expenses arose from administering an allergy skin test, hiring and training high school graduates as environmental counselors, buying air filters and vacuum cleaners and engaging pest management services when needed. Vacuum cleaners served to effectively remove cockroach droppings, dust mites, animal dander and other dirt that can trigger asthma attacks in susceptible people.

The cost per symptom-free day for each child was $25.57, investigators found. Asthmatic children in the study used 13 percent fewer B-agonist inhalers for relieving symptoms over the two-year study.

Dr. Meyer Kattan of Mount Sinai School of Medicine, Dr. Sally Stearns of the University of North Carolina at Chapel Hill School of Public Health and colleagues conducted the study. A report on their work appears in the current issue of the Journal of Allergy and Clinical Immunology.

"We demonstrated that a comprehensive home-based environmental intervention that was tailored to the child's exposures resulted in decreased symptoms and unscheduled doctor visits," Kattan said. "Costs could be reduced substantially if the intervention were implemented in a non-research setting, and its cost-effectiveness would be similar to that of many drug interventions."

Scheduled medical visits, hospital days, emergency room visits and medications used all declined, the scientists found.

"The home-based intervention is particularly advantageous as it addresses some of the underlying causes of asthma in a cost-effective manner instead of simply treating the disease symptoms," Stearns said. "The analysis probably understates the full benefit of the intervention as we only measured the health effects for each study participant instead of for the entire family."

The research was part of the Inner-City Asthma Study, a rigorous national collaborative investigation aimed at reducing the growing burden of asthma on U.S. children and health-care facilities. Although 937 U.S. children were enrolled in the study, the analysis was limited to the 800 for whom complete information was available.

Other authors included Drs. Ellen F. Crain of the Albert Einstein College of Medicine in Bronx, N.Y., James W. Stout of the University of Washington in Seattle, Peter J. Gergen of the National Institute of Allergy and Infectious Diseases, Richard Evans III of Northwestern University in Chicago, Cynthia M. Visness and Herman E. Mitchell of Rho, Inc. of Chapel Hill, Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center at Dallas, Wayne J. Morgan of the University of Arizona, George T. O'Connor of Boston University and J. Patrick Mastin of the National Institute of Environmental Health Sciences.

Source: Eurekalert & others

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