Enhancing ventilation in homes of children with asthma: cost-effectiveness study alongside randomised controlled trial

Authors: Edwards, Rhiannon T1; Neal, Richard D2; Linck, Pat1; Bruce, Nigel3; Mullock, Linda4; Nelhans, Nick5; Pasterfield, Diana2; Russell, Daphne6; Russell, Ian7; Woodfine, Louise4

Source: British Journal of General Practice, 1 November 2011, vol. 61, no. 592, pp. e733-e741(9)


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There has been little rigorous economic analysis of the relationship between asthma and improved housing.


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.


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.


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.


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.

Keywords: asthma; children; clinical trials, randomised; general practice; health; housing; quality of life

Document Type: Research Article

DOI: http://dx.doi.org/10.3399/bjgp11X606645

Affiliations: 1: Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor 2: Public Health Wales, Wrexham 3: Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham 4: Division of Public Health, University of Liverpool, Liverpool 5: North Wales Organisation for Randomised Trials in Health and Social Care, College Of Health And Behavioural Sciences, Bangor University, Bangor 6: Department of Primary Care and Public Health, North Wales Clinical School, Cardiff University, Wrexham 7: College of Medicine, Swansea University, Swansea

Publication date: November 1, 2011


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