School-based therapy reduces asthma symptoms

Feb 16th – Among asthmatic children, those receiving school-based therapy had more symptom-free days than those receiving their usual care.

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1. Among asthmatic children, those receiving school-based therapy had more symptom-free days than those receiving their usual care.

2. Children with persistent asthma gained the most symptom-free days from school-based therapy, at an estimated cost of $6/day gained.

Study findings showed that among asthmatic urban children, a school-based therapy program increased symptom-free days at an additional cost of ≤ $10 per symptom-free day gained. These results have particularly promising implications in the treatment of urban children with persistent asthma, who gained the most symptom-free days from school-based therapy. While this study did not demonstrate direct reduction in healthcare costs, incorporation of indirect costs of asthma suggests that school-based therapy may be more cost-effective than previously thought.  These results underscore the importance of considering direct and indirect costs associated with childhood illnesses such as asthma.

Limitations of the study include asthma symptoms reported by parental proxy, which could overestimate the benefit of school-based therapy. Further, cost-effectiveness was based on Medicaid costs such that results cannot be reliably applied to non-Medicaid populations. A key strength of this study is randomization as well as the incorporation of indirect asthma-related costs into the cost-effectiveness model. A study with extended longitudinal follow-up and empirically collected economic data could more definitely explore the findings of the present work.

Click to read the study in Pediatrics

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1. Among asthmatic children, those receiving school-based therapy had more symptom-free days than those receiving their usual care.

2. Children with persistent asthma gained the most symptom-free days from school-based therapy, at an estimated cost of $6/day gained.

This [randomized] trial: examined the clinical and cost-effectiveness of the School-Based Asthma Therapy trial on 525 asthmatic children ages 3-10 who attended urban preschool or elementary schools. Children were assigned to school-based therapy received a daily dose of preventive asthma medication by a school nurse on weekdays and parents on weekends for one school year (7-9 months), while children in the control group received their usual care over the same time period. Participants were randomized by disease severity, environmental exposures (smoking in the home), and demographics (Medicaid eligibility, caregiver education, age, sex, race, and ethnicity) Symptom-free days, direct measures of cost-effectiveness (cost of program administration less reduced medical costs), and indirect measures of cost-effectiveness (lost productivity, school absenteeism) were assessed via monthly telephone interviews with independent researchers for the duration of the school year.

Compared to children receiving their usual care, those participating in school-based therapy had more symptom-free days (2556 and 2398 days per 30-day period per child, respectively; p=0.001) and fewer missed school days (60 and 84 days per 30-day period per 100 children, respectively; p=0.014). Persistent asthmatics derived even greater benefit from school-based therapy compared to those receiving usual care (2471 and 2292 symptom-free days per 30-day period per 100 children, respectively; p<0.01). Overall, school-based therapy cost $10/symptom-free day gained and was most cost-effective in children with persistent asthma at an estimated cost of $6/symptom-free day gained.

In sum: This study showed that among asthmatic urban children, a school-based therapy program increased symptom-free days at an additional cost of ≤ $10 per symptom-free day gained. These results have particularly promising implications in the treatment of urban children with persistent asthma, who gained the most symptom-free days from school-based therapy. While this study did not demonstrate direct reduction in healthcare costs, incorporation of indirect costs of asthma suggests that school-based therapy may be more cost-effective than previously thought.  These results underscore the importance of considering direct and indirect costs associated with childhood illnesses such as asthma.

Limitations of the study include asthma symptoms reported by parental proxy, which could overestimate the benefit of school-based therapy. Further, cost-effectiveness was based on Medicaid costs such that results cannot be reliably applied to non-Medicaid populations. A key strength of this study is randomization as well as the incorporation of indirect asthma-related costs into the cost-effectiveness model. A study with extended longitudinal follow-up and empirically collected economic data could more definitely explore the findings of the present work.

Click to read the study in Pediatrics

By Caroline Huang and Leah Hawkins

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