School-Based Asthma Therapy Effective and Cost-effective

Troy Brown

February 11, 2013

The School-Based Asthma Therapy (SBAT) program, which uses school nurses to administer preventive asthma medication each day, is both effective and cost-effective, according to a study published online February 11 in Pediatrics.

Katia Noyes, PhD, MPH, from the Department of Surgery at the University of Rochester in New York, and colleagues analyzed data from the SBAT trial to determine the program's cost-effectiveness. The trial included 525 children aged 3 to 10 years from urban preschools and elementary schools. The primary outcome of this analysis was mean number of symptom-free days (SFDs).

After baseline assessment, participants were stratified on the basis of exposure to cigarette smoke in the home and then randomly assigned to receive either a single dose of preventive asthma medication (fluticasone propionate or fluticasone with salmeterol xinafoate) from the school nurse each day or usual care (UC). Parents were responsible for medications on nonschool days.

Across all use categories, the mean number of acute visits including prednisone administration was 1.45 for the children in the SBAT group compared with 1.74 for the children in the UC group (per 100 children per month; P = .56).

The children in the SBAT group also had a lower average number of missed school days, with 60 per 100 children per month compared with 84 in the UC group (P = .01).

$50 Per Child Per Month

The researchers estimated programmatic costs to be $4822 per 100 children per month, including salary and benefits for a nurse educator and a research assistant.

Parents' missed work days cost, on average, $4893 (standard error [SE], $516] for the SBAT group compared with $6813 (SE, $555) for the UC group. The resulting incremental difference was $1920.

Schools saved on average $943 (SE, $371) in school attendance fees losses due to because of improved attendance that resulted from the asthma intervention.

There was no significant difference in total healthcare costs between the groups. However, after considering costs including reduced healthcare costs, reduced productivity, and attendance losses, the program saved $3240. The overall difference between this savings and the programmatic costs of $4822 per 100 children per month is $1583. The program cost $48 per child per month.

The number of symptom-free days gained was significant and equal to 158 additional SFDs a month per 100 children (P < .05), with a cost per SFD of $10 (95% confidence interval [CI], −$4 to $46). An additional 1.79 SFDs per month per child were gained in the group with more severe asthma. Excluding indirect costs, the incremental cost-effectiveness ratio equaled $28 per SFD (95% CI, $18 - $75).

Reduced absenteeism in the SBAT group could save an average of $1146 in lost school funding compared with the control group. This savings was increased in the group with more severe asthma (incremental cost-effectiveness ratio, $5.62 per SFD; 95% CI, −$12.80 to $46.61), including all costs.

Costs could be reduced further by using school administrative personnel instead of the research assistant for symptom screening (from $10/SFD to $7/SFD for all children and from $6/SFD to $2/SFD for children with more severe asthma).

The study was funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Noyes received grant funding from the National Center for Research Resources (a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research). The study was funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 11, 2013. Abstract