RVA Breathes: Costs of a System of Community-Based Interventions to Improve Asthma Care

Pediatric asthma disparities persist. In a randomized, controlled trial (2017-2022), the Richmond, Virginia (RVA) Breathes program, which was a series of community-based asthma interventions, was tested in a sample of 250 children (5-11 years; 78% African American/Black). Results suggested reduced asthma-related hospitalizations for the full intervention arm (asthma education, home environment remediation, and school intervention). Leveraging detailed costs from program expense reports, this study analyzed the costs of the RVA Breathes full intervention. Five-year costs of the full intervention were $1 922 514 (on average $3314 annually per participating household). Personnel costs contributed the largest share (74.8%), followed by overhead costs (18.9%). Costs for follow-up, outreach staff, and academic leadership were key cost drivers. When restricting these cost drivers collectively, as in a public health implementation approach, average annual costs per participating household decreased by 45.0%. In practice, streamlining the implementation of the RVA Breathes full intervention could improve program affordability.