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A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program

Gomez, Marta MS; Reddy, Amanda L. MS; Dixon, Sherry L. PhD; Wilson, Jonathan MPH; Jacobs, David E. PhD, CIH

Journal of Public Health Management and Practice: March/April 2017 - Volume 23 - Issue 2 - p 229–238
doi: 10.1097/PHH.0000000000000528
Special Section: Evaluating the Impact of the New York State Healthy Neighborhoods Program: Research Articles
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Context: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services.

Objective: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program.

Design: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012.

Setting: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors.

Participants: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year.

Intervention: The program provides home environmental assessments and low-cost interventions to address asthma trigger–promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit.

Main Outcome Measures: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period.

Results: For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311.

Conclusion: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

Supplemental Digital Content is Available in the Text.

New York State Health Department, Albany, New York (Ms Gomez); and National Center for Healthy Housing, Columbia, Maryland (Ms Reddy, Drs Dixon and Jacobs and Mr Wilson).

Correspondence: Amanda L. Reddy, MS, National Center for Healthy Housing, 10320 Little Patuxent Pkwy, Ste 500, Columbia, MD 21044 (areddy@nchh.org).

The authors thank the New York State Department of Health staff who administer the Healthy Neighborhoods Program and contributed to this work: Joan Bobier, Kenneth Boxley, Michael Cambridge, Thomas Carroll, Philip DiMura, and Lloyd Fox; the coordinators and staff at the county health departments; and the residents who welcomed them into their homes. The authors thank the staff of the Erie, Orange, Schenectady, and Clinton County Health Departments for their help in completing the time estimation study; Ruth Lindberg for assistance in designing the time estimation study; Trang Nguyen, Melissa Lurie, and Victoria Wagner of the New York State Department of Health for their assistance in acquiring and interpreting Medicaid data; and Tursynbek Nurmagambetov for his advice in designing a cost-benefit analysis.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.