AbstractsMedical & Health Science

Asthma is a common chronic condition of childhood that results in frequent exacerbations associated with school absences, emergency department visits, and hospitalizations. School-based case detection to identify children with undiagnosed or poorly controlled asthma may reduce asthma morbidity; however, it is uncertain whether the resources consumed by case detection are justified by the expected improvements in health outcomes. Cost-effectiveness analysis using a decision tree with multiple Markov models to simulate asthma-related costs and outcomes in primarily urban, low-income, African-American, elementary-age school children is performed. Modeled health states include symptom free, symptomatic, and exacerbation recovery days, as well as emergency department visits and hospitalizations. The time horizon is one year divided into 365 cycles. Two questionnaire only and two multi-stage interventions incorporating spirometry only or spirometry and exercise testing are evaluated. The analysis is performed from the societal perspective and is reported in 2006 dollars per quality adjusted life year (QALY) gained. The multi-stage with spirometry and exercise testing (MSwET) intervention is the most cost-effective intervention, with an incremental cost-effectiveness ratio (ICER) of $107,200 per QALY. Probabilistic sampling demonstrates that 90% of the observed ICERs fall between $47,400 and $155,500 per QALY. Ninety-five percent of the uncertainty observed in sensitivity analysis is due to the estimation of the quality of life preference weight for the symptomatic health state and asthma prevalence. In its most favorable valuation, the symptomatic state preference weight yields an ICER of $40,900 per QALY. School-based asthma case detection in the modeled population is unlikely to be cost-effective at $50,000 per QALY; however, if the symptomatic state preference weight is significantly lower or the asthma prevalence is significantly higher than estimated, this finding may not hold. The MSwET intervention, which incorporates spirometry and exercise testing with a symptom-based questionnaire, maximizes true positive results, minimizes false positive results, and is consistently the most cost-effective intervention. Limitations include reliance on secondary data, uncertainty regarding quality of life weights for clinically relevant asthma health states, and limited knowledge of actual health outcomes experienced by children newly diagnosed with asthma by case detection. 1 online resource (xiii, 135 p. : ill., digital, PDF file) Health Services Administration; Health Professions; asthma cost-effectiveness screening schools pediatric case detection UNRESTRICTED