Journal article
Cost-effectiveness of school integrated pest management and air filtration in students with asthma
Allergy and asthma proceedings, Vol.46(3), pp.257-266
05/01/2025
DOI: 10.2500/aap.2025.46.250018
PMCID: PMC12118139
PMID: 40380354
Abstract
Background: The cost-effectiveness of school environmental remediation in asthma is not known. The School Inner City Asthma Intervention Study (SICAS2) was a randomized controlled trial that assessed school integrated pest management (IPM) and classroom high efficiency particulate
air (HEPA) filtration on asthma morbidity in urban schools. Objective: The objective was to evaluate the cost-effectiveness of SICAS2. Methods: We conducted a cost-effectiveness analysis from a societal perspective that compared four interventions: IPM,
HEPA, IPM + HEPA, and no intervention. Quality-adjusted life years (QALY) were derived from the EuroQol-5 Dimension-Youth and EuroQol-5 Dimension-3 levels instruments. Total costs (2021 U.S. dollars) included intervention cost, cost of caregiver productivity impacted by child school absenteeism,
and health-care utilization costs (e.g., emergency department visits). The evaluation period was based on a mean follow-up time of 166 days. Sensitivity analyses were performed by using cost estimates 50% above and below initial cost benchmarks. Results: A total of 154
SICAS2 participants were included. Intervention costs per student were $12.21 (IPM + HEPA), $7.27 (IPM), and $4.94 (HEPA). Sequential analyses revealed that IPM + HEPA was the most cost-effective option, with an incremental cost-effectiveness ratio of $19,667 per
QALY. Sensitivity analyses demonstrated stability, with variability in probability estimates not exceeding 10%. Conclusion: IPM + HEPA demonstrated good value to society, which reflected the low cost and the economic impact of missed school days. This intervention may have
a pronounced benefit for historically minoritized and marginalized children in urban schools who are disproportionately exposed to air pollution and indoor allergens. The SICAS2 intervention may offer a cost-effective tool to target proximal causes of disparities even in the most resource-limited
schools.
Details
- Title: Subtitle
- Cost-effectiveness of school integrated pest management and air filtration in students with asthma
- Creators
- Carmela Socolovsky - Massachusetts General HospitalMargee Louisias - Harvard UniversitySaleh Alsulami - Boston Children's HospitalCarter R. Petty - Boston Children's HospitalMichelle Trivedi - University of Massachusetts Chan Medical SchoolPeggy S. Lai - Massachusetts General HospitalAmparito Cunningham - Brigham and Women's HospitalJonathan Gaffin - Boston Children's HospitalPeter Thorne - University of IowaBrent Coull - University of Massachusetts Chan Medical SchoolPetros Koutrakis - University of Massachusetts Chan Medical SchoolAndrea Baccarelli - University of Massachusetts Chan Medical SchoolDiane J. Gold - Harvard UniversityGary Adamkiewicz - Department of Environmental Health, Harvard T.H. Chan School of Public HealthPerdita Permaul - Texas Health DallasTina Banzon - Harvard UniversityMarissa Hauptman - Harvard UniversityLisa M. Bartnikas - Harvard UniversitySachin Baxi - Harvard UniversityWilliam J. Sheehan - Boston Children's HospitalWanda Phipatanakul - Harvard UniversityMihail Samnaliev - Axtria Inc., Berkeley Heights, NJ
- Resource Type
- Journal article
- Publication Details
- Allergy and asthma proceedings, Vol.46(3), pp.257-266
- DOI
- 10.2500/aap.2025.46.250018
- PMID
- 40380354
- PMCID
- PMC12118139
- NLM abbreviation
- Allergy Asthma Proc
- ISSN
- 1088-5412
- eISSN
- 1539-6304
- Publisher
- OceanSide Publications, Inc; PROVIDENCE
- Grant note
- National Institutes of Health: K24AI106822, U01AI110397 Harvard Catalyst / The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health): UL1 TR002541 Harvard University
This study was supported by grants K24AI106822 and U01AI110397 from the National Institutes of Health. In addition, support was provided from Harvard Catalyst / The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR002541) and financial contributions from Harvard University and its affiliated academic health-care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health-care centers, or the National Institutes of Health
- Language
- English
- Date published
- 05/01/2025
- Academic Unit
- Civil and Environmental Engineering; Occupational and Environmental Health
- Record Identifier
- 9984823076102771
Metrics
47 Record Views