Modeled cost-effectiveness of the experience corps baltimore based on a pilot randomized trial
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The Experience Corps® program was designed to harness the social capital of an aging society to improve outcomes for public elementary schools. The objectives of this article are (1) to model the cost-effectiveness of the Experience Corps Baltimore using data from a pilot randomized trial, including costs, older adults’ health status, and quality of life and cost data from the Medical Expenditure Panel Survey, and (2) to describe the relationship between children experiencing increased expected lifetime earnings through improved educational attainment resulting from exposure to the Experience Corps Baltimore volunteers and the program’s costs and cost-effectiveness. On average, each quality adjusted life year (QALY) gained by older adults in Experience Corps Baltimore costs $205,000. The lower bound of the 95% confidence interval for the cost-effectiveness is $65,000/QALY. The upper bound is undefined as 15% of the simulations indicated no QALY improvements, If 0,3% of students exposed to the Experience Corps Baltimore changed from not graduating to graduating, the increased lifetime earnings would make the incremental cost-effectiveness ratio $49,000/QALY. If an additional 0,1% changed to graduating from high school, the program would be cost-saving. Using conservative modeling assumptions and excluding benefits to teachers, principals, and the surrounding community, the Experience Corps Baltimore appears expensive for the older adults’ health improvements, but requires only small long-term benefits to the target children to make the program cost-effective or cost-saving.
- Erikson EH. The Life Cycle Completed: a Review. New York: WW Norton; 1982.
- Glass TA, Carlson M, Hill J, et al. Experience Corps Baltimore: design of an intergenerational health-promotion program to boost social capital. J Urban health. 2004;81(1):94–105.
- Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37:433–440.
- Fried LP, Carlson M, Freedman M et al. A social model for health promotion for an aging population: initial evidence on the Experience Corps Baltimore model. J Urban health. 2004;81(1):64–78.
- Rebok GW, Glass TA, Carlson M et al. Effects of Experience Corps Baltimore participation on young children, teachers, and schools: results from a randomized pilot trial. J Urban health. 2004;81(1):79–93.
- Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
- Freedman M, Fried L. Launching Experience Corps: Findings From a 2-Year Pilot Project Mobilizing Older Americans to Help Inner-City Elementary School. Oakland, CA: Civic Ventures; January 1999.
- Inflation calculator Web site. Available at: http://data.bls.gov/cgi-bin/cpicalc.pl. Accessed September 28, 2003.
- Bierman AS, Bubolz TA, Fisher ES, Wasson JH. How well does a single question about health predict the financial health of Medicare managed care plans. Eff Clin Pract. 1999;2(2):56–62.
- Rizzo JA, Pashko S, Friedkin R, Mullahy J, Sindelar JL. Linking the health utilities index to National Medical Expenditure Survey data. Pharmacoeconomics. 1998;13:531–541. CrossRef
- Simon CP, Blume L. Mathematics for Economists. New York: WW Norton; 1994.
- Wells W, Harschbarger S. Microsoft ® Excel 97 Developer’s Handbook. Redmond, WA: Microsoft Press; 1997.
- Agency for Healthcare Research and Quality Center for Cost and Financing Studies. MEPS HC-050: 2000 Full Year Consolidated Data File, 2003.
- Medical Expenditure Panel Survey Web-site. Available at: http://www.meps.ahrq.gov/ Puf/DataResultsData.asp?ID=130. Accessed September 29, 2003.
- Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35:1095–1108. CrossRef
- Stata Statistical Software: Release 8.0. College Station, TX: Stata Corporation; 2003.
- Mullahy J. Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ. 1998;17:247–281. CrossRef
- Ai C, Norton EC. Standard errors for the retransformation problem with heteroscedasticity. J Health Econ. 2000;19:697–718. CrossRef
- Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;18:341–364. CrossRef
- Briggs AH, O’Brien BJ, Blackhouse G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health. 2002;23:377–401. CrossRef
- Report Card 2003 Web site. Available at: http://msp.msde.state.md.us/gradrate.asp? K=30AAAA. Accessed September 28, 2003.
- Day JC, Newburger EC. The Big Payoff: Educational Attainment and Synthetic Estimates of Work-Life Earnings. Washington, DC: US Census Bureau; 2002. P23–210.
- Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making. 2000;20:332–342.
- LaPlante MP, Harrington C, Kang T. Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home. Health Serv Res. 2002;37:397–415. CrossRef
- Murrell SA, Meeks S. Psychological, economic, and social mediators of the education-health relationship in older adults. J Aging Health. 2002;14:527–550.
- Weimer DL, Wolkoff MJ. School performance and housing values: using non-contiguous district and incorporation boundaries to identify school effects. Natl Tax J. 2001;54:231–253.
- Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness, Risk Anal. 1995;15:369–390.
- Weikart DP. Changing early childhood development through educational intervention. Prev Med. 1998;27:233–237. CrossRef
- Reynolds AJ, Temple JA, Robertson DL, Mann EA. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: a 15-year follow-up of low-income children in public schools. JAMA. 2001;285:2339–2346. CrossRef
- Carlson MC, Seeman T, Fried LP. Importance of generativity for healthy aging in older women. Aging (Milano). 2000;12:132–140.
- Modeled cost-effectiveness of the experience corps baltimore based on a pilot randomized trial
Journal of Urban Health
Volume 81, Issue 1 , pp 106-117
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Experience Corps
- Older adults’ health status
- Children’s increased lifetime earnings
- Public elementary schools
- Author Affiliations
- 1. Johns Hopkins Bloomberg School of Public Health, Health Services Research, 624 North Broadway, Room 606, 21205-1901, Baltimore, MD