RT Journal Article
SR Electronic
T1 Enhancing ventilation in homes of children with asthma: cost-effectiveness study alongside randomised controlled trial
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e733
OP e741
DO 10.3399/bjgp11X606645
VO 61
IS 592
A1 Rhiannon T Edwards
A1 Richard D Neal
A1 Pat Linck
A1 Nigel Bruce
A1 Linda Mullock
A1 Nick Nelhans
A1 Diana Pasterfield
A1 Daphne Russell
A1 Ian Russell
A1 Louise Woodfine
A1 ,
YR 2011
UL http://bjgp.org/content/61/592/e733.abstract
AB Background There has been little rigorous economic analysis of the relationship between asthma and improved housing.Aim To evaluate the cost-effectiveness of installing ventilation systems, and central heating if necessary, in homes of children with ‘moderate’ or ‘severe’ asthma.Design and setting An incremental cost-effectiveness analysis alongside a pragmatic randomised controlled trial of a tailored package of housing modifications designed to improve ventilation and household heating in homes within Wrexham County Borough, Wales, UK.Method A total of 177 children aged between 5 and 14 years, identified from general practice registers, were studied. Parents reported on the quality of life of their children over a 12-month period. General practices reported on health-service resources used by those children, and their asthma-related prescriptions, over the same period.Results The tailored package shifted 17% of children in the intervention group from ‘severe’ to ‘moderate’ asthma, compared with a 3% shift in the control group. The mean cost of these modifications was £1718 per child treated or £12300 per child shifted from ‘severe’ to ‘moderate’. Healthcare costs over 12 months following randomisation did not differ significantly between intervention and control groups. Bootstrapping gave an incremental cost-effectiveness ratio (ICER) of £234 per point improvement on the 100-point PedsQL™ asthma-specific scale, with 95% confidence interval (CI) = £140 to £590. The ICER fell to £165 (95% CI = £84 to £424) for children with ‘severe’ asthma.Conclusion This novel and pragmatic trial, with integrated economic evaluation, reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public resources. This is a rare example of evidence for collaboration between local government and the NHS.