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RVA Breathes: Costs of a System of Community-Based Interventions to Improve Asthma Care
Zhongzhe Pan1,2, Robin S Everhart1,2, Sarah Morton1,2
1Author Affiliations: Department of Health Policy, School of Public Health, Virginia Commonwealth University, Richmond, Virginia (Dr Pan and Dr Kimmel); Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia (Dr Everhart, Dr Morton, and Ms Miller); and Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (Dr Kimmel).
Insights
The Richmond, Virginia (RVA) Breathes program reduced pediatric asthma hospitalizations. Streamlining interventions can decrease program costs by 45%, enhancing affordability for public health implementation.
Area of Science:
- Public Health
- Pediatric Asthma Management
- Health Economics
Background:
- Pediatric asthma disparities remain a significant public health concern, particularly in minority communities.
- Community-based interventions show promise in mitigating asthma-related health burdens.
Purpose of the Study:
- To analyze the costs associated with the full Richmond, Virginia (RVA) Breathes program, a community-based pediatric asthma intervention.
- To identify key cost drivers and explore potential cost reductions for broader implementation.
Main Methods:
- A randomized controlled trial (2017-2022) involving 250 children (5-11 years) with asthma.
- Detailed cost analysis using program expense reports for the full intervention (asthma education, home remediation, school intervention).
Main Results:
- The five-year cost of the RVA Breathes full intervention was $1,922,514 (average $3314/household annually).
- Personnel (74.8%) and overhead (18.9%) were the largest cost categories.
- Restricting key cost drivers (follow-up, outreach, leadership) reduced average annual costs by 45.0%.
Conclusions:
- The RVA Breathes program demonstrated effectiveness in reducing asthma hospitalizations.
- Streamlining implementation strategies can significantly improve the affordability of community-based pediatric asthma interventions for public health initiatives.
Abstract:
Pediatric asthma disparities persist. In a randomized, controlled trial (2017-2022), the Richmond, Virginia (RVA) Breathes program, which was a series of community-based asthma interventions, was tested in a sample of 250 children (5-11 years; 78% African American/Black). Results suggested reduced asthma-related hospitalizations for the full intervention arm (asthma education, home environment remediation, and school intervention). Leveraging detailed costs from program expense reports, this study analyzed the costs of the RVA Breathes full intervention. Five-year costs of the full intervention were $1 922 514 (on average $3314 annually per participating household). Personnel costs contributed the largest share (74.8%), followed by overhead costs (18.9%). Costs for follow-up, outreach staff, and academic leadership were key cost drivers. When restricting these cost drivers collectively, as in a public health implementation approach, average annual costs per participating household decreased by 45.0%. In practice, streamlining the implementation of the RVA Breathes full intervention could improve program affordability.
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