Cost-Consequence Analysis of Multimodal Interventions with Environmental Components for Pediatric Asthma in the State of Maryland

Abstract

Background. Applied environmental strategies for asthma control are often expensive, but may save longer-term healthcare costs. Whether these savings outweigh additional costs of implementing these strategies is uncertain. Methods. We conducted a systematic review to estimate the expenditures and savings of environmental interventions for asthma in the state of Maryland. Direct costs included hospitalizations, emergency room, and clinic visits. Indirect expenditures included costs of lost work productivity and travel incurred during the usage of healthcare services. We used decision analysis, assuming a hypothetical cohort of the approximated 49,290 pediatric individuals in Maryland with persistent asthma, to compare costs and benefits of environmental asthma interventions against the standard of care (no intervention) from the societal perspective. Results. Three interventions among nine articles met the inclusion criteria for the systematic review: 1) environmental education using medical professionals; 2) education using non-medical personnel; and 3) multi-component strategy involving education with non-medical personnel, allergen-impermeable covers, and pest management. All interventions were found to be cost-saving relative to the standard of care. Home environmental education using non-medical professionals yielded the highest net savings of $14.1 million (95% simulation interval (SI): $-.283 million, $19.4 million), while the multi-component intervention resulted in the lowest net savings of $8.1 million (95% SI: $-4.9 million, $15.9 million). All strategies were most sensitive to the baseline number of hospitalizations in those not receiving targeted interventions for asthma. Conclusions. Limited environmental reduction strategies for asthma are likely to be cost-saving to the healthcare system in Maryland and should be considered for broader scale-up in other economically similar settings.

• cost analysis
• economics
• health outcomes
• health policy
• health system

Acknowledgments

We are grateful to Kelli Rostkowski, Mary Bonacci, and Barbara Ensor of the Department of Pediatrics (Johns Hopkins School of Medicine) for providing charge data on asthma outcomes at Johns Hopkins Children’s Center.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. No potential conflict of interest exists with any companies or organizations whose products and services may be discussed in this article. This study was not funded by any grant. The study investigators have nothing to disclose.