Air Pollution and Respiratory Health Branch, Division of Health Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia 30341, USA.
Am J Prev Med. 2011 Aug;41(2 Suppl 1):S33-47. doi: 10.1016/j.amepre.2011.05.011.
A recent systematic review of home-based, multi-trigger, multicomponent interventions with an environmental focus showed their effectiveness in reducing asthma morbidity among children and adolescents. These interventions included home visits by trained personnel to assess the level of and reduce adverse effects of indoor environmental pollutants, and educate households with an asthma client to reduce exposure to asthma triggers. The purpose of the present review is to identify economic values of these interventions and present ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios, and incremental cost-effectiveness ratios).
Using methods previously developed for Guide to Community Preventive Services economic reviews, a systematic review was conducted to evaluate the economic efficiency of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. A total of 1551 studies were identified in the search period (1950 to June 2008), and 13 studies were included in this review. Program costs are reported for all included studies; cost-benefit results for three; and cost-effectiveness results for another three. Information on program cost was provided with varying degrees of completeness: six of the studies did not provide a list of components included in their program cost description (limited cost information), three studies provided a list of program cost components but not a cost per component (partial cost information), and four studies provided both a list of program cost components and costs per component (satisfactory cost information).
Program costs per participant per year ranged from $231-$14,858 (in 2007 U.S.$). The major factors affecting program cost, in addition to completeness, were the level of intensity of environmental remediation (minor, moderate, or major), type of educational component (environmental education or self-management), the professional status of the home visitor, and the frequency of visits by the home visitor. Benefit-cost ratios ranged from 5.3-14.0, implying that for every dollar spent on the intervention, the monetary value of the resulting benefits, such as averted medical costs or averted productivity losses, was $5.30-$14.00 (in 2007 U.S.$). The range in incremental cost-effectiveness ratios was $12-$57 (in 2007 U.S.$) per asthma symptom-free day, which means that these interventions achieved each additional symptom-free day for net costs varying from $12-$57.
The benefits from home-based, multi-trigger, multicomponent interventions with an environmental focus can match or even exceed their program costs. Based on cost-benefit and cost-effectiveness studies, the results of this review show that these programs provide a good value for dollars spent on the interventions.
最近一项针对以家庭为基础、多触发因素、多成分且以环境为重点的干预措施的系统评价显示，这些干预措施可有效降低儿童和青少年的哮喘发病率。这些干预措施包括由经过培训的人员进行家访，以评估室内环境污染物的水平并减少其不良影响，并对有哮喘患者的家庭进行教育以减少哮喘诱因的暴露。本综述的目的是确定这些干预措施的经济价值，并介绍主要经济结果（例如，项目成本、成本效益比和增量成本效益比）的范围。
使用先前为社区预防服务指南经济评价制定的方法，进行了一项系统评价，以评估以家庭为基础、多触发因素、多成分且以环境为重点的干预措施在改善与哮喘相关的发病率结果方面的经济效率。在搜索期间（1950 年至 2008 年 6 月）共确定了 1551 项研究，其中有 13 项研究被纳入本综述。所有纳入的研究均报告了项目成本；其中三项研究报告了成本效益结果；另有三项研究报告了成本效果结果。提供了项目成本信息，但完整程度不同：有六项研究没有提供项目成本描述中包含的组成部分清单（提供有限的成本信息），三项研究提供了项目成本组成部分清单但没有每个组成部分的成本（提供部分成本信息），四项研究同时提供了项目成本组成部分清单和每个组成部分的成本（提供满意的成本信息）。
每位参与者每年的项目成本从 231 美元到 14858 美元不等（2007 年美国美元）。除了完整性之外，影响项目成本的主要因素还包括环境修复的强度（轻微、中度或重度）、教育组成部分的类型（环境教育或自我管理）、家访人员的专业地位以及家访人员的访问频率。成本效益比范围从 5.3 到 14.0，这意味着每花费 1 美元用于干预措施，干预措施所带来的经济价值（如避免的医疗费用或避免的生产力损失）为 5.30 美元到 14.00 美元（2007 年美国美元）。增量成本效益比的范围为 12 美元到 57 美元（2007 年美国美元）/哮喘无症状日，这意味着这些干预措施每获得一个额外的无症状日，其净成本从 12 美元到 57 美元不等。
以家庭为基础、多触发因素、多成分且以环境为重点的干预措施的收益可以与其成本相匹配，甚至超过成本。基于成本效益和成本效果研究，本综述的结果表明，这些计划为干预措施的支出提供了很好的价值。
