Program to Reduce Asthma Triggers Worth Its Cost

NEW YORK (Reuters Health) - Home-based efforts to reduce the amount of allergy triggers in the homes of children with asthma not only work well but also appear to be worthwhile in terms of costs and savings, new findings show.

"Our previous study demonstrated that an intervention designed to reduce the exposure of asthmatic inner-city children to environmental irritants and allergens at home succeeded in reducing asthma symptoms," study author Dr. Meyer Kattan told Reuters Health.

"The current study shows that a reduction in morbidity can be achieved with this home-based environmental intervention in a cost-effective manner," added Kattan, of Mount Sinai School of Medicine in New York City.

Asthma is known to be particularly common among children living in the inner city, and is thought to be partially due to various environmental factors such as exposure to cockroach antigen and other indoor allergy-producing substances and irritants.

Findings from the previously published Inner-City Asthma Study showed that a home-based intervention was successful in reducing the levels of such irritants and allergens.

That intervention used trained environmental counselors to teach families to use pillow covers that are impermeable to dust mites, air purifiers to get rid of tobacco smoke or mold, and other ways to reduce exposure to various asthma triggers. The study participants were more than 900 children, aged 6 to 11, with moderate-to-severe asthma from seven urban locations, nationwide.

The current study was conducted to evaluate the cost-effectiveness of the initiative.

The intervention cost $1,469 per family, but it reduced the study participants' annual number of unscheduled visits to the clinic by 19 percent and reduced the number of asthma inhalers used each year by 13 percent, Kattan and colleagues report.

This reduction in the use of asthma services was "sufficient to offset approximately one third of the intervention costs," they write in the Journal of Allergy and Clinical Immunology.

During the two-year study period, including one year of follow-up, children in the study group had nearly 40 more symptom-free days -- at a cost of about $28 per day -- than did children in a comparison group.

Whether the intervention is cost-effective, i.e. worth its cost to the payer, depends on how much the payer values symptom-free days, the report suggests.

According to Kattan, the current findings "support current international asthma guidelines stating that attention to exposures in the home environment is an integral part of asthma management."

In light of the findings, Kattan recommends that "environmental interventions should be considered as an important part of public health programs for asthma management of children in inner-cities."

"This economic analysis can be useful for prioritizing decisions regarding asthma care in this underserved population," the researcher added.

SOURCE: Journal of Allergy and Clinical Immunology, online October 11, 2005.