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Your Environment. Your Health.

A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost-benefit analysis (CBA)
Fabian MP, Adamkiewicz G, Stout NK, Sandel M, and Levy JI
J Allergy Clin Immunol
This cost-benefit analysis used a previously developed discrete event simulation model (DEM) of pediatric asthma to estimate differences in healthcare use costs comparing home-based interventions and intervention bundles for a simulated cohort of children in low-income multifamily housing in Boston, Massachusetts. The study authors determined that interventions, such as repairing kitchen exhaust fans and integrated pest management, led to 7% and 12% reductions in serious asthma events, respectively, with one- to three-year payback periods. This work increases the awareness of multi-intervention approaches to control asthma and highlights the cost-benefits of environmental home interventions.
Simulated cohort of one million children living in low-income, multifamily housing consistent with public housing residents

Health Outcomes

  • Respiratory outcomes (asthma, lung function)

Environmental Agents

List of Environmental Agents:

  • Air pollutants (nitrogen dioxide, particulate matter (PM2.5/fine), indoor allergens (cockroach, mold))

Source of Environmental Agents:

  • Sources of indoor air pollution, allergens from pests (cockroaches)

Economic Evaluation / Methods and Source


  • Cost-benefit analysis (CBA)

Cost Measured:

  • Healthcare costs related to pediatric asthma (medications/prescriptions)
  • healthcare costs related to serious asthma events (e.g.,. clinic visits, ED visits, hospitalizations)
  • asthma symptom days
  • medication use
  • intervention costs
  • energy costs

Potential Cost Measures:

  • Lost work days
  • missed school days

Benefits Measures:

  • Healthcare savings
  • reduction of indoor air pollutants and allergen concentrations resulting from interventions
  • reduction of pediatric asthma and poor lung function outcomes resulting from interventions
  • energy savings

Potential Benefits: (Not available)


  • Boston, Massachusetts

Models Used:

  • Simulation models — Discrete event simulation model (DEM) of pediatric asthma
  • CONTAM model

Methods Used:

  • Authors used a simulated cohort of children to evaluate the impact of building interventions on indoor environmental quality and pediatric asthma healthcare use, and conducted cost comparisons between intervention, healthcare costs, and energy savings. The authors — 1) used a previously developed and evaluated discrete event simulation model (DEM) of pediatric asthma to simulate health outcomes over a range of building interventions; 2) modeled indoor concentrations of four contaminants that potentially affect a child's lung function and asthma status (i.e., nitrogen dioxide, PM2.5, cockroach allergen, and mold); 3) evaluated several candidate interventions for improving indoor environmental conditions, and considered an intervention aimed at reducing energy costs; and 4) tested bundles of interventions that couple weatherization with interventions that can potentially offset indoor environmental effects.

Sources Used:

  • 2007/2008 Massachusetts Medicaid Reimbursement Survey (American Academy of Pediatrics, 2008); Medical Expenditure Panel Survey (MEPS) (Barnett et al., 2011); 2006 Agency for Healthcare Research and Quality Healthcare cost and utilization project (Stranges et al., 2008); Medical Care Consumer Price Index (US Department of Labor, 2013); Housing conditions and respiratory health in a Boston public housing community (Brugge et al., 2011); Use of a population-based study to describe the health of Boston public housing residents (Digenis-Bury et al., 2008); Public health and the physical environment in Boston Public Housing: a community-based survey and action agenda (Hynes et al., 2000); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Fabian MP, Adamkiewicz G, Stout NK, Sandel M, and Levy JI. 2014. A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs. J Allergy Clin Immunol.
  • Pubmed
  • DOI

NIEHS Funding:

  • R21ES017522

Other Funding: (Not available)

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