|
New Study on Childhood Asthma Shows
Home-Based Interventions Are Cost-Effective
New data suggest that a home-based environmental intervention
program is a cost-effective way to improve the health of inner-city
children who have moderate to severe asthma. The program
successfully decreased allergen levels in the home and reduced
asthma symptoms. The data also show that the cost would be
substantially lower if the interventions were implemented in a
community setting, and that they would be as cost-effective as many
drug interventions.
The National Institute of Allergy and Infectious Diseases (NIAID),
part of the National Institutes of Health (NIH), provided major
funding to researchers at seven centers across the United States for
the two-year study. The National Institute of Environmental Health
Sciences (NIEHS), part of NIH, also supported the research. Study
results are now available online in the Journal of Allergy and
Clinical Immunology.
“While the interventions were clearly effective in reducing
asthma symptoms, we wanted to know whether the measures were
cost-effective,” says Meyer Kattan, M.D., a pediatric pulmonologist
with the Mount Sinai School of Medicine and lead author on the
study.
The home-based program was designed to target six major classes
of allergens that trigger asthma symptoms—dust mites, cockroaches,
pet dander, rodents, passive smoking and mold. The environmental
interventions were tailored to each child’s sensitivity to the
selected allergens and evidence of exposure to these asthma
triggers.
Those enrolled in the program received educational home visits
that included specific measures for reducing or eliminating allergen
levels inside the home. These included allergen-impermeable covers
on the child’s mattress, box spring and pillows; air purifiers with
high efficiency particulate air (HEPA) filters; vacuum cleaners
equipped with HEPA filters; and professional pest control.
The home-based interventions resulted in significant improvement
in health status and reductions in resource use among the asthmatic
children. Children who received the intervention had 19 percent
fewer unscheduled clinic visits and a 13 percent reduction in the
use of albuterol inhalers, small applicators that deliver asthma
medication directly into the lungs. Children in the intervention
group experienced 38 more symptom-free days over the two-year course
of the study than those in the control group.
“These results show that tailored interventions such as these may
have a substantial long-term impact on asthma symptoms and resource
use among inner-city children,” says NIEHS Director David A.
Schwartz, M.D. “They may be particularly beneficial for asthmatic
children who are exposed to multiple allergens and lack the proper
access to quality health care.”
To evaluate the cost-effectiveness of the program, the
researchers calculated the direct costs of the services provided to
each child, along with an estimate of the symptom-free days gained
as a result of the interventions. “The asthma intervention resulted
in an average increase of 37.8 symptom-free days over the two-year
period, at an estimated cost of $27.57 per symptom-free day,” says
Dr. Kattan.
“The findings of this study will enable policy makers and health
care providers to more effectively allocate resources to achieve
maximum benefits,” says Peter J. Gergen, M.D., M.P.H, of NIAID’s
Division of Allergy, Immunology and Transplantation, an author on
the paper.
The study is part of the larger Inner-City Asthma Study, a
multicenter project created to evaluate the effectiveness of
environmental interventions on asthma incidence. The study
participants included more than 900 children, ages 5 to 11, with
moderate to severe asthma.
Most of the children were African American or Hispanic, living in
low-income sections of seven urban areas—the Bronx, Boston, Chicago,
Dallas, Manhattan, Seattle/Tacoma and Tucson. Each child had to be
allergic to at least one common indoor allergen, such as cockroach
or house dust mite allergen.
NIAID is a component of the National
Institutes of Health, an agency of the U.S. Department of Health and
Human Services. NIAID supports basic and applied research to
prevent, diagnose and treat infectious diseases such as HIV/AIDS and
other sexually transmitted infections, influenza, tuberculosis,
malaria and illness from potential agents of bioterrorism. NIAID
also supports research on transplantation and immune-related
illnesses, including autoimmune disorders, asthma and allergies.
NIEHS, a component of the National
Institutes of Health, supports research to understand the effects of
the environment on human health. For more information about asthma,
please visit our website at
http://www.niehs.nih.gov/airborne/. For more information on
other environmental health topics, you may visit our home page at
www.niehs.nih.gov.
###
Reference:
M Kattan et al.
Cost-effectiveness of a home-based environmental intervention for
inner-city children with asthma.
Journal of Allergy and Clinical
Immunology DOI:10.1016/j.jaci.2005.07.032 |
