|Equation||(# adults receiving services) x (% improved houses solely because of this program) x (% health and safety problems present in the home are resolved) x (# QALY increase) x ($ QALY)|
|Explanation||This metric estimates the impact of housing quality improvements on improved health for adults, specifically reduced asthma triggers, estimated in terms of quality-adjusted life years (QALY).
Percentage of adults receiving housing: Reported by program
% of improved houses solely because of this program: [100%], the percentage of houses that receive services helpful enough to improve health conditions solely because of this program is estimated by Constellation Fund staff using program data. We assume a 100% rate of service for programs covering 100% of the cost of the renovation and serving individuals who would have not been able to do improvements without the support of the program. If the program covers a fraction of the improvements, we use the percent of costs paid by the program.
Percentage of health and safety problems present in the home which are resolved: [20%], the estimated benefits in this metric depend on the extent to which the health and safety problems are present in the homes of participants. We use program data to determine this incidence. If no program data is available, we use 20% as the prevalence rate. Adult Current Asthma Prevalence by Race/Ethnicity, BRFSS, 2008 = 11.3% (CDC, 2015). The prevalence of asthma among black individuals is twice the rate in the general population (CDC, 2008). Thus, we approximate the rate of low-income individuals to be at least 20% (1.75 x 11.3). (Since we do not know rates of asthma by income in Minnesota, we use the rates for black adults as a proxy for low-income adults.)
QALY increase: [0.02], we estimate a 0.02 QALY value for the remediation of asthma triggers subsequent to housing quality improvement based on the findings of Muennig, Glied & Simon (2005), who report that a comprehensive asthma intervention of medical, education and self-help support produces a 0.05 QALY improvement in the lives of the patients, while medical-only care produces on average 0.03 QALY improvement (Schermer et al, 2002). We apply the 0.02 QALY difference (0.05 – 0.03 = 0.02) as the value of the decrease in home-based asthma triggers through the improvement in quality of the home environment.
$ value per QALY: [$50,000]
Benefits are then discounted to present value based on the average age of participation to life expectancy.
|References||Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed Sep 24, 2018]. URL: https://www.cdc.gov/brfss/brfssprevalence/
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (2008). Asthma in MN. Retrieved from: https://www.cdc.gov/asthma/stateprofiles/Asthma_in_MN.pdf
Muennig, P., Glied, S. & Simon, J. (2005). Estimation of the health benefits produced by Robin Hood Foundation grant recipients. Report to Robin Hood. New York, NY: Robin Hood.
Schermer, T. R., Thoonen, B. P, van den Boom, G., Akkermans, R. P., Grol, R. P., Folgering, H. T., van Weel,C. & van Schayck, C. P. (2002). Randomized controlled economic evaluation of asthma self-management in primary health care. American Journal of Respiratory and Critical Care Medicine, 166, 1062-1072.