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Randomized Controlled Trial
. 2025 May 1;46(3):257-266.
doi: 10.2500/aap.2025.46.250018.

Cost-effectiveness of school integrated pest management and air filtration in students with asthma

Carmela Socolovsky  1 , Margee Louisias  2 , Saleh Alsulami  3 , Carter R Petty  4 , Michelle Trivedi  5 , Peggy S Lai  1 , Amparito Cunningham  6 , Jonathan Gaffin  7 , Peter Thorne  8 , Brent Coull  9 , Petros Koutrakis  9 , Andrea Baccarelli  10 , Diane R Gold  2 , Gary Adamkiewicz  9 , Perdita Permaul  11 , Tina Banzon  2 , Marissa Hauptman  2 , Lisa M Bartnikas  2 , Sachin Baxi  2 , William J Sheehan  3 , Wanda Phipatanakul  2 , Mihail Samnaliev  12
Affiliations
Randomized Controlled Trial

Cost-effectiveness of school integrated pest management and air filtration in students with asthma

Carmela Socolovsky et al. Allergy Asthma Proc. .

Abstract

Background: The cost-effectiveness of school environmental remediation in asthma is not known. The School Inner City Asthma Intervention Study (SICAS2) was a randomized controlled trial that assessed school integrated pest management (IPM) and classroom high efficiency particulate air (HEPA) filtration on asthma morbidity in urban schools. Objective: The objective was to evaluate the cost-effectiveness of SICAS2. Methods: We conducted a cost-effectiveness analysis from a societal perspective that compared four interventions: IPM, HEPA, IPM + HEPA, and no intervention. Quality-adjusted life years (QALY) were derived from the EuroQol-5 Dimension-Youth and EuroQol-5 Dimension-3 levels instruments. Total costs (2021 U.S. dollars) included intervention cost, cost of caregiver productivity impacted by child school absenteeism, and health-care utilization costs (e.g., emergency department visits). The evaluation period was based on a mean follow-up time of 166 days. Sensitivity analyses were performed by using cost estimates 50% above and below initial cost benchmarks. Results: A total of 154 SICAS2 participants were included. Intervention costs per student were $12.21 (IPM + HEPA), $7.27 (IPM), and $4.94 (HEPA). Sequential analyses revealed that IPM + HEPA was the most cost-effective option, with an incremental cost-effectiveness ratio of $19,667 per QALY. Sensitivity analyses demonstrated stability, with variability in probability estimates not exceeding 10%. Conclusion: IPM + HEPA demonstrated good value to society, which reflected the low cost and the economic impact of missed school days. This intervention may have a pronounced benefit for historically minoritized and marginalized children in urban schools who are disproportionately exposed to air pollution and indoor allergens. The SICAS2 intervention may offer a cost-effective tool to target proximal causes of disparities even in the most resource-limited schools.

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Conflict of interest statement

M. Louisias received support from the National Institutes of Health (NIH), National Heart, Lung, and Blood Institute Grant L30 HL143781, Brigham and Women’s Hospital Minority Faculty Career Development Award, and a Robert A. Winn Diversity in Clinical Trials Career Development Award funded by the Bristol Myers Squibb Foundation; is a consultant for RubiconMD; has served on an advisory board for Sanofi; and is an employee of Sanofi. J. Gaffin is supported by National Institute of Environmental Health Sciences R01ES030100 and the American Lung Association (IA-1050758); receives research grants from the NIH, Vertex Pharmaceuticals, GlaxoSmithKline, and consulting fees from Syneos Health. M. Trivedi is supported by asthma-related NIH grants (K23HL150341, R01HL169229, and R01HL174599). The remaining authors have no conflicts of interest to declare pertaining to this article

Figures

Figure 1.
Figure 1.
Cost-effectiveness analysis curve (CEAC): the CEAC compares the three interventions to the probability of cost-effectiveness at various WTP thresholds. For instance, at a WTP of $100,000/QALY, the combined IPM + HEPA intervention group demonstrated an 85% probability of being cost-effective. WTP = Willingness to pay; QALY = quality-adjusted life year; IPM = integrated pest management; HEPA = high efficiency particulate air.
Figure 2.
Figure 2.
Cost-effectiveness plot: this figure illustrates the ICER probabilistic sensitivity analysis plots for the interventions (IPM and HEPA) on the cost-effectiveness plane. The WTP slope is plotted, showing that 85% of the probability plots fall under the WTP slope, which indicates the cost-effectiveness of the interventions at the societal WTP. ICER = Incremental cost effectiveness ratio; IPM = integrated pest management; HEPA = high efficiency particulate air; WTP = willingness to pay.
See this image and copyright information in PMC

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