Strategies to identify relevant behaviors and costs in family asthma management
- Presenter:
Chair: Melayne McInnes; Discussant: TBA Tue June 6, 2006 13:45-15:15 Room 121
Despite promulgation of national and international guidelines on the effective management of pediatric asthma, asthma-related morbidity among urban children remains disproportionately high. While there is ample evidence of persistent health disparities by race/ethnicity and income, there is a lack of understanding of the causal mechanism(s)for these disparities. The lack of conception of the relevant causal pathway proves challenging for the implementation of interventions designed to mitigate the burden of asthma in urban communities. Further, without an appropriate causal model, measuring changes in health outcomes due to interventions, as well as determining the economic value of these changes, becomes problematic. These two methodological issues are central concerns in benefit-cost studies. Each of these issues are complicated by the correlation between poor health outcomes and socioeconomic characteristics. Models of the impact of health interventions on specific health endpoints are likely to be biased due to unobservable variables that determine health outcomes and are correlated with standard SES variables. The problem is especially likely to occur in cases of health programs that target high-risk populations such as urban children who suffer from asthma.
In this presentation, we outline how a methodology to value non-market goods, contingent valuation, can be used to collect data for both 1) modeling household behavior and asthma outcomes and 2) cost-benefit assessment of a health intervention program. We will provide empirical data obtained from a CDC asthma intervention, in Oakland, CA, targeting urban adolescents and their families. Our focus will be on the ecological and familial influences on health-related decisions using contingent valuation to elicit an individual’s willingness to pay (WTP) for a particular non-market good (i.e. a reduction in asthma symptoms) using a hypothetical scenario that characterizes a realistic market good that affords the non-market benefit of interest. The association of WTP with asthma severity and health beliefs points to factors to explicate family demand for asthma management programs. The degree and nature of family participation in asthma management may partially explain the observed disparities in asthma morbidity by socioeconomic and demographic characteristics. With respect to pediatric asthma, contingent valuation is useful framework to understand how families would assign a monetary value to reduce asthma severity and improve quality of life for their children. The correlation between change in behaviors and symptoms and WTP can identify sub-populations that may benefit the most from community-based asthma interventions.
In addition, utilizing this approach, assessment of non-market costs related to asthma can inform the design of interventions to mitigate the burden of asthma among urban populations. Although direct and indirect costs related to asthma care have been well established, the non-market costs of asthma provide a more accurate picture of the overall economic burden of asthma. The use of these non-market costs to measure asthma morbidity and gauge the effectiveness of programs to improve asthma management has profound implications for the delivery and the evaluation interventions designed to reduce asthma prevalence in urban communities.
