Quality-of-Life and Cost–Benefit Analysis of a Home Environmental Assessment Program in Connecticut

Abstract

Background. The National Asthma Education Prevention Program's (NAEPP) Expert Panel Report 3 (EPR3) guidelines have stressed the need for environmental control measures for asthma, but there is limited evidence of their efficacy. Objective. To examine the effectiveness of an in-home asthma intervention program for children and adults in Connecticut, we conducted a panel study to analyze quality-of-life indicators for asthmatic patients and the cost–benefit relationship in preventive care versus acute care. Methods. The Asthma Indoor Reduction Strategies (AIRS) program was developed to reduce acute asthma episodes and improve asthma control through patient education and a home environmental assessment. Follow-up was conducted at 2-week, 3-month, and 6-month intervals. Measured quality-of-life indicators included number of unscheduled acute care visits, days absent from school/work due to asthma, times rescue inhaler used, and number of symptom-free days. Repeated measures analysis of variance (ANOVA) was used to determine whether significant differences exist in quality-of-life indicators at follow-up compared to that at the initial visit. Cost–benefit analysis was conducted by tabulating costs associated with physician office visits and emergency department (ED) visits due to asthma for children and adults separately. Results. Twenty percent of participants in the program met the criteria for well-controlled asthma, 16% for not well-controlled asthma, and 64% for very poorly controlled asthma. At 6 months follow-up, the mean number of unscheduled acute care visits, days absent from school/work due to asthma, and times rescue inhaler used in the past week decreased by 87%, 82%, and 74%, respectively, whereas the mean number of symptom-free days increased by 27% compared to the initial visit. Furthermore, the percent of participants with very poorly controlled asthma decreased from 64% at initial visit to 13% at 6 months follow-up. All changes were statistically significant at p < 0.05. A net savings of $26,720 per 100 participants was estimated at 6 months follow-up due to decreases in unscheduled acute care visits for adults and children. Conclusion. Significant improvement in quality-of-life and decreases in healthcare resource utilization and costs were found after implementation of the AIRS program in Connecticut.

• asthma
• cost–benefit analysis
• environmental exposure
• intervention studies
• quality-of-life

Acknowledgments

The authors would like to thank state and local health departments for contributing to the success of the program. In addition, we would like to thank Archie Swindell, PhD, for his efforts in analyzing data on the pilot study which helped lay the foundation for this work. We are also deeply grateful to Doug Brugge, PhD, from Tufts University School of Medicine and Jon Olson, PhD, from Connecticut Department of Public Health who helped in the review of this article. Funding for this study was provided by the Centers for Disease Control and Prevention, Grant Number 5U59EH124179-05.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.