A Cost-Effectiveness Analysis of a Community Health Worker Led Asthma Education Program in South Texas

Figures & data

Table 1 Baseline Descriptive Statistics of Demographics for Children and Parents

Variables	Baseline
	Mean (SD) or %	Number of Observations
Children’s Demographics
Age (average)	8.99 (3.99)	348
Gender: Female (%)	44.41	349
Race (%)		345
Black/African-American	0.87
White/Caucasian	0.29
Spanish or Hispanic	97.68
Other Race	1.16
Parents’ demographics
Age (average)
Mom	37.01 (7.29)	349
Dad	39.75 (8.58)	320
Marital Status (%)		348
Married	69.25
Separated	12.64
Divorced	5.17
Widowed	2.01
Single	10.92
Survey Taker’s Demographics
Age (average)	36.98 (7.95)	349
Gender: Female (%)	95.13	349
Relationship (%)		349
Parent	95.13
Grandparent	4.01
Another relative	0.86
Household income (%)		331
Less than $14,999	52.27
$15,000-$29,999	35.65
$30,000-$60,000	9.37
More than $60,000	2.72

Abbreviation: SD, Standard Deviation.

Table 2 Outcome Variables Between Baseline and Follow-Up

Variables	Total		Mean		p-value	Obs.
	Pre	Post	Pre	Post
Outcome Variables
# of Asthma Attacks	11.071	1.067	0.032 (0.115)	0.003 (0.012)	<0.001	349
# of Hospital Visits	0.357	0.033	0.001 (0.013)	0.0001 (0.001)	0.174	348
# of ER Visits	1.000	0.267	0.003 (0.016)	0.0008 (0.005)	0.016	348
Physical Health of Children	202	224	76.29 (19.65)	90.43 (11.98)	<0.001	345
Activities of Children	252	261	88.29 (21.59)	93.62 (14.03)	<0.001	348
Activities of Family	226	255	88.27 (16.67)	91.69 (16.36)	<0.001	348
Emotional Health of Children	218	228	70.36 (34.30)	81.61 (27.11)	<0.001	347
Emotional Health of Family	183	183	63.48 (17.80)	69.62 (14.12)	<0.001	348

Notes: Values in the Total column represent the number of households scoring above average for the following outcomes: Physical Health of Children, Activities of Children, Activities of Family, Emotional Health of Children, and Emotional Health of Family. Standard deviations are shown in parentheses and italicized. The number of asthma attacks, hospital visits, and ER visits is standardized across the baseline and follow-up surveys to reflect the number of times per day.

Table 3 Program Costs (in 2018 Dollars)

	Program ($)	Per Household ($)
Administrative	74,359.00	213.07
Materials	12,296.30	35.23
Total	86,655.30	248.30

Note: Total program costs are calculated using a total participant number of 349.

Table 4 Pre-Cost, Post-Cost, and Cost Differences by Category

Category	Num	Pre-Cost ($)	Post-Cost ($)	Cost Difference ($)	p-values
Overall	336
Hospital Stays		12.48 (151.43)	1.16 (15.07)	−11.31 (152.23)	0.174
ER Visits		18.76 (102.65)	5.00 (35.02)	−13.76 (104.04)	0.016
Travel Time to ER		0.19 (1.06)	0.15 (0.96)	−0.05 (1.27)	0.488
Doctor Visits		20.26 (34.60)	6.40 (12.08)	−13.86 (32.72)	0.000
Travel Time to Doctor		0.39 (2.13)	0.29 (1.92)	−0.10 (2.54)	0.488
Medication		122.09 (95.59)	133.34 (88.15)	11.25 (109.82)	0.061
Missing School Days		5.84 (18.15)	1.11 (4.15)	−4.73 (17.20)	0.000
Missing Work Days		4.74 (14.39)	0.90 (3.27)	−3.84 (13.06)	0.000
Total		184.75 (286.63)	148.36 (106.45)	−36.39 (257.80)	0.010
Child Gender	336
Female	150	168.58 (145.12)	137.03 (97.97)	−31.54 (141.78)	0.007
Male	186	197.79 (336.65)	157.50 (112.25)	−40.29 (322.68)	0.090
Female Guardian’s Education	335
Less than high school	126	173.15 (185.68)	142.11 (97.11)	−31.05 (185.89)	0.063
High school graduate	102	178.60 (191.26)	163.68 (95.64)	−14.93 (187.89)	0.424
More than high school	107	205.91 (389.37)	140.24 (124.70)	−65.67 (365.54)	0.066
Male Guardian’s Education	310
Less than high school	120	184.39 (191.61)	153.13 (103.21)	−31.26 (184.06)	0.065
High school graduate	110	185.75 (372.05)	140.03 (118.98)	−45.72 (356.39)	0.181
More than high school	80	163.29 (164.65)	147.09 (96.76)	−16.19 (158.30)	0.363
Household Income:	318
Less than $14,999	163	206.40 (335.27)	146.83 (114.93)	−59.57 (319.30)	0.018
$15,000 - $29,999	115	172.11 (181.97)	142.71 (104.30)	−29.40 (180.70)	0.084
$30,000 - $69,000	31	177.17 (228.86)	158.67 (81.27)	−18.50 (203.71)	0.617
More than $60,000	9	82.25 (116.80)	158.47 (105.68)	76.21 (116.02)	0.084
Child age	335
0–6 years	117	169.47 (181.86)	147.58 (113.56)	−21.90 (169.61)	0.165
7–12 years	152	200.25 (352.30)	150.59 (99.42)	−49.66 (336.81)	0.071
13–19 years	66	178.40 (152.33)	146.53 (110.28)	−31.87 (163.81)	0.119
Guardian age	334
20–30 years	61	143.22 (128.74)	135.41 (128.31)	−7.80 (113.60)	0.594
31–40 years	164	200.92 (341.19)	141.10 (98.85)	−59.81 (325.22)	0.020
41–50 years	96	179.07 (194.51)	167.33 (102.49)	−11.74 (192.59)	0.552
More than 50 years	13	212.07 (193.13)	153.06 (114.38)	−59.02 (208.00)	0.326

Note: Standard deviations are shown in parentheses and italicized.

Table 5 Cost-Effectiveness Ratios Overall

Category	Outcome	Cost-Effectiveness Ratio
Overall:
Asthma Attacks (#)	61	248.30/61 = 4.1
Hospital Visits (#)	3	248.30/3 = 82.8
ER Visits (#)	12	248.30/12 = 20.7
Physical Health of Children (#)	265	248.30/265 = 0.9
Activities of Children (#)	111	248.30/111 = 2.2
Activities of Family (#)	142	248.30/142 = 1.7
Emotional Health of Children (#)	161	248.30/161 = 1.5
Emotional Health of Family (#)	222	248.30/222 = 1.1

Notes: Cost-effectiveness ratio = average cost/outcome measure; The outcome measure is the number of participants who reported a better outcome (ie, an increase in the physical health of children, activities of children/family, and emotional health of children/family and a decrease in asthma attacks, hospital visits, and ER visits). For example, if a participant reports less asthma attacks at the follow-up, they are included in the 61 outcome measure.

Table 6 Cost Benefit Ratio for Total Household Cost Difference Pre to Post

Category	Outcome ($)	Cost Benefit Ratio
Overall:
Total Household Cost Difference	36.39	$36.39/$248.30 = 0.147

Note: Cost-Benefit ratio = average household cost difference/average program cost per household.