Cost-effectiveness of a government rebate program for air cleaners in preventing asthma and related adverse health outcomes
Notice bibliographique
Résumé
ABSTRACT Background Wildfire-derived fine particulate matter (PM 2.5 ) is an increasing contributor to air pollution in British Columbia (BC), Canada, and is linked to asthma development and asthma-related adverse outcomes including exacerbations. Portable high-efficiency particulate air (HEPA) cleaners can reduce indoor PM 2.5 , but evidence on their long-term, population-level cost-effectiveness is limited. Methods We developed a monthly, time-varying Markov cohort model (2010–2035; healthcare payer perspective; 1.5% annual discounting; $50,000/QALY willingness-to-pay) for two BC cohorts (age 5 and age 25 at baseline) across 16 Health Service Delivery Areas (HSDAs). The model simulated monthly transitions between health states (well-controlled asthma, not well-controlled asthma, exacerbations, and death) over a 25-year time horizon (2010–2035). The target population was children age 5 and adults aged 25 (separate cohorts). We combined historical total PM 2.5 (2010–2022) from provincial data sources with projected PM 2.5 (2023–2035) combining anthropogenic emissions with wildfire-derived PM 2.5 . Wildfire PM 2.5 projections were calculated by multiplying monthly PM 2.5 averages from 2018–2022 by 0%, 5.5%, and 11% cumulative PM 2.5 increase scenarios, informed by climate modeling. The base-case rebate was $150, and varied rebates between $50 to $200. We assumed continuous use with unit replacement every 5 years and filter replacement every 9 months. We calculated asthma incidence attributable to wildfire PM 2.5 and incremental cost-effectiveness ratios (ICERs) across BC’s 16 Health Service Delivery Areas (HSDAs). We conducted the analysis from a health payer perspective with a 1.5% discount rate and $50,000/QALY willingness to pay threshold. Costs are expressed in 2024 CAD. Results From 2023–2036, wildfire-derived PM 2.5 was associated with 13–14 incident asthma cases per 100,000 person-years annually across BC. Over 25 years, air cleaners prevented 444 moderate exacerbations, 55 emergency department visits, and 42 hospitalizations (combined cohorts), but the base-case program was not cost-effective in any HSDA (ICER range: $149,408–$154,749/QALY). A $50 rebate was cost-effective province-wide and $100 was cost-effective in three HSDAs. Results were most sensitive to concentration-response functions for PM2.5 (incidence, control, exacerbations) and to HEPA air cleaner and asthma care costs. Cost-effectiveness was most sensitive to air cleaner costs and the concentration-response function between PM 2.5 and asthma incidence. Conclusions Wildfire-related PM 2.5 contributes meaningfully to asthma incidence in BC. A universal $150 HEPA rebate program was not cost-effective for primary prevention under base-case assumptions, whereas lower rebates ($50 province-wide, $100 in three HSDAs) may offer better value. Future evaluations should co-benefits across multiple disease outcomes to better support policies to reduce the health impacts of increasing wildfires.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».