A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents with Asthma: Findings from the New York State Healthy Neighborhoods Program

Project Funder: U.S. Department of Housing and Urban Development (HUD)

Project Partner: The New York State Department of Health

Project Contact: Amanda Reddy, areddy@nchh.org, 443.539.4152

Project Description: Evidence suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation. From 2008 to 2012, the U.S. Department of Housing and Urban Development (HUD) funded a study to evaluate the impact of a large-scale, multisite, state-funded healthy homes program. The New York State Healthy Neighborhoods Program (NYS HNP) is distinct from previously evaluated programs in its scale, geographic scope, and funding structure. Although the program is nearly 30 years old, the evaluation focused on a five-year period after the implementation of a standardized data collection instrument. This unique data set included information about services provided to more than 29,000 homes with 82,000 residents in 13 counties across the state of New York.

Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few healthcare payers reimburse or provide coverage for these services. For this study, the objective was to evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program.

The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed three to six months after the initial visit.

Participating in the study were 1,000 households comprised of 550 children and 731 adults who met the criteria for active asthma (the “Active Asthma” group), as well as 791 households with 448 children and 551 adults who in addition to having active asthma also experienced an asthma attack or medical encounter for worsening asthma (ED visit, urgent care visit, or hospitalization) in the previous year (the “Asthma Event” group).

Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period were measured as part of the study. For the asthma event group, the per-person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit-to-program-cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, the per-person savings was $613 per asthma visit, with a benefit-to-program-cost ratio of 2.03 and net benefit of $311.

The study determined that investment in low-intensity, home-based, environmental interventions for people with asthma ultimately decreases the cost of healthcare utilization. Even greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale.

Resources

Gomez, M., Reddy, A. L., Dixon, S. L., Wilson, J., & Jacobs, D. E. (2017, March-April). A cost-benefit analysis of a state-funded healthy homes program for residents with asthma: Findings from the New York State Healthy Neighborhoods ProgramJournal of Public Health Management and Practice, 23(2), 229-238.

Digital Supplement: NYSDOH Healthy Neighborhoods Program Asthma Form [pdf]

Related Studies

In a series of three peer-reviewed articles, we presented findings from a retrospective evaluation of this large-scale, multisite, state-funded healthy homes initiative. These are the other two projects related to this evaluation:

The New York State Healthy Neighborhoods Program: Findings from an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program [url]

An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children [url]