***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There has been little rigorous economic analysis of the relationship between asthma and improved housing . AIM To evaluate the cost-effectiveness of installing ventilation systems , and central heating if necessary , in homes of children with ' moderate ' or ' severe ' asthma . DESIGN AND SETTING An incremental cost-effectiveness analysis alongside a pragmatic r and omised controlled trial of a tailored package of housing modifications design ed to improve ventilation and household heating in homes within Wrexham County Borough , Wales , UK . METHOD A total of 177 children aged between 5 and 14 years , identified from general practice registers , were studied . Parents reported on the quality of life of their children over a 12-month period . General practice s reported on health-service re sources used by those children , and their asthma-related prescriptions , over the same period . RESULTS The tailored package shifted 17 % of children in the intervention group from ' severe ' to ' moderate ' asthma , compared with a 3 % shift in the control group . The mean cost of these modifications was £ 1718 per child treated or £ 12300 per child shifted from ' severe ' to ' moderate ' . Healthcare costs over 12 months following r and omisation did not differ significantly between intervention and control groups . Bootstrapping gave an incremental cost-effectiveness ratio ( ICER ) of £ 234 per point improvement on the 100-point PedsQL ™ asthma-specific scale , with 95 % confidence interval ( CI ) = £ 140 to £ 590 . The ICER fell to £ 165 ( 95 % CI = £ 84 to £ 424 ) for children with ' severe ' asthma . CONCLUSION This novel and pragmatic trial , with integrated economic evaluation , reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public re sources . This is a rare example of evidence for collaboration between local government and the NHS Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service setting s. We present the cost effectiveness of Advancing Better Living for Elders ( ABLE ) , previously shown in a r and omized trial to reduce functional difficulties and mortality in 319 community-dwelling elders . ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties , performance goals , and home safety . Incremental cost-effectiveness ratio ( ICER ) , expressed as additional cost to bring about one additional year of life , was calculated . Two models were then developed to account for potential cost differences in implementing ABLE . Probabilistic sensitivity analyses were conducted to account for variations in model parameters . By two years , there were 30 deaths ( 9 : ABLE ; 21 : control ) . Additional costs for 1 additional year of life was $ 13,179 for Model 1 and $ 14,800 for Model 2 . Investment in ABLE may be worthwhile depending on society 's willingness to pay Aims To assess the cost-effectiveness of installing thermostatic mixer valves ( TMVs ) in reducing risks of  bath water scalds  and estimate the costs of avoiding bath water scalds . Methods The evaluation was undertaken from the perspective of the UK public sector , and conducted in conjunction with a r and omised control trial of TMVs installed in social housing in Glasgow . Installation costs were borne by the social housing organisation , while support material s were provided by the UK NHS . Effectiveness was represented by the number of families with at-risk bath water temperatures pre- and post-installation , and the number of bath scalds avoided as a result of installation . Differences in the number of families with at-risk temperatures between groups were derived from the RCT . Cost-effectiveness was assessed and a series of one-way sensitivity analyses were conducted . Results Unit costs associated with installation were calculated to be £ 13.68 , while costs associated with treating bath water scalds ranged from £ 25 226 to £ 71 902 . The cost of an avoided bath water scald ranged from net savings to public purse of £ 1887 to £ 75 520 and at baseline produced a net saving of £ 3 229 008 ; that is , £ 1.41 saved for every £ 1 spent . Conclusion It is very likely that installing TMVs as st and ard in social housing in new buildings and major refurbishments accompanied by educational information represents value for money . Trial registration number IS RCT N:21179067 BACKGROUND In 2001 , 486 deaths and 17,300 injuries occurred in domestic fires in the UK . Domestic fires represent a significant cost to the UK economy , with the value of property loss alone estimated at pounds 375 million in 1999 . In 2001 in the US , there were 383 500 home fires , result ing in 3110 deaths , 15,200 injuries and dollar 5.5 billion in direct property damage . METHODS A cluster RCT was conducted to determine whether a smoke alarm give-away program , directed to an inner-city UK population , is effective and cost-effective in reducing the risk of fire-related deaths/injuries . Forty areas were r and omized to the give-away or control group . The number of injuries/deaths and the number of fires in each ward were collected prospect ively . Cost-effectiveness analysis was undertaken to relate the number of deaths/injuries to re source use ( damage , fire service , healthcare and give-away costs ) . Analytical methods were used which reflected the characteristics of the trial data including the cluster design of the trial and a large number of zero costs and effects . RESULTS The mean cost for a household in a give-away ward , including the cost of the program , was pounds 12.76 , compared to pounds 10.74 for the control ward . The total mean number of deaths and injuries was greater in the intervention wards then the control wards , 6.45 and 5.17 . When an injury/death avoided is valued at pounds 1000 , a smoke alarm give-away has a probability of being cost effective of 0.15 . CONCLUSIONS A smoke alarm give-away program , as administered in the trial , is unlikely to represent a cost-effective use of re sources Background : Housing is an important environmental influence on population health , and there is growing evidence of health effects from indoor environment characteristics such as low indoor temperatures . However , there is relatively little research , and thus little firm guidance , on the cost-effectiveness of public policies to retrospectively improve the st and ards of houses . The purpose of this study was to value the health , energy and environmental benefits of retrofitting insulation , through assessing a number of forms of possible benefit : a reduced number of visits to GPs , hospitalisations , days off school , days off work , energy savings and CO2 savings . Methods : All these metrics are used in a cluster r and omised trial — the “ Housing , Insulation and Health Study ” —of retrofitting insulation in 1350 houses , in which at least one person had symptoms of respiratory disease , in predominantly low-income communities in New Zeal and . Results : Valuing the health gains , and energy and CO2 emissions savings , suggests that total benefits in “ present value ” ( discounted ) terms are one and a half to two times the magnitude of the cost of retrofitting insulation . Conclusion : This study points to the need to consider as wide a range of benefits as possible , including health and environmental benefits , when assessing the value for money of an intervention to improve housing quality . From an environmental , energy and health perspective , the value for money of improving housing quality by retrofitting insulation is compelling Background Despite much success in reducing the burden of malaria in Vietnam , pockets of malaria persist and eliminating them remains an important development goal . In central Vietnam , insecticide-treated hammocks have recently been introduced to help counter the disease in the highly forested , mountainous areas , where other measures have so far been unsuccessful . This study assesses the cost-effectiveness of using long-lasting insecticide-treated hammocks in this area . Methods and Findings This cost-effectiveness study was run alongside a r and omized control trial testing the efficacy of the long-lasting insecticide-treated hammocks . Data were collected through an exit survey , a household survey , expenditure records and key informant interviews . The study estimates that under normal ( non-trial ) conditions the total net societal cost per malaria episode averted in using long-lasting insecticide-treated hammocks in this area was 126 USD . Cost per hammock , including insecticidal netting , sewing , transport , and distribution was found to be approximately 11.76 USD per hammock . Average savings per episode averted were estimated to be $ 14.60 USD for the health system and 14.37 USD for households ( including both direct and indirect cost savings ) . The study estimates that the annual financial outlay required of government to implement this type of programme to be 3.40 USD per person covered per year . Conclusion The study finds that the use of a hammock intervention could represent good value for money to help prevent malaria in more remote areas , where traditional control measures such as insecticide-treated bednets and indoor residual spraying are insufficient or inappropriate to control malaria . However , the life span of the hammock – the number of years over which it effectively deters mosquitoes – has a significant impact on the cost-effectiveness of the intervention and study results should be interpreted in light of the evidence on effectiveness gathered in the years to come OBJECTIVES To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults . DESIGN Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature . SETTING Model represents population level interventions . PARTICIPANTS No human subjects were involved in the study . MEASUREMENS : The last Cochrane data base review and meta-analyses of r and omized controlled trials categorized effective fall-prevention interventions into seven groups : medical management ( withdrawal ) of psychotropics , group tai chi , vitamin D supplementation , muscle and balance exercises , home modifications , multifactorial individualized programs for all elderly people , and multifactorial individualized treatments for high-risk frail elderly people . Fall-related hip fracture incidence was obtained from the literature . Salary figures for health professionals were based on Bureau of Labor Statistics data . Using an integrated healthcare system perspective , healthcare costs were estimated based on practice and studies on falls in older adults . Base case incremental cost utility ratios were calculated , and probabilistic sensitivity analyses were conducted . RESULTS Medical management of psychotropics and group tai chi were the least-costly , most-effective options , but they were also the least studied . Excluding these interventions , the least-expensive , most-effective options are  vitamin D supplementation and home modifications . Vitamin D supplementation costs less than home modifications , but home modifications cost only $ 14,794/ quality -adjusted life year ( QALY ) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi , home modification is most likely to have the highest economic benefit when QALYs are valued at $ 50,000 or $ 100,000 . CONCLUSION Of single interventions studied , management of psychotropics and tai chi reduces costs the most . Of more-studied interventions , home modifications provide the best value . These results must be interpreted in the context of the multifactorial nature of falls Objective To determine whether insulating existing houses increases indoor temperatures and improves occupants ' health and wellbeing . Design Community based , cluster , single blinded r and omised study . Setting Seven low income communities in New Zeal and . Participants 1350 households containing 4407 participants . Intervention Installation of a st and ard retrofit insulation package . Main outcome measures Indoor temperature and relative humidity , energy consumption , self reported health , wheezing , days off school and work , visits to general practitioners , and admissions to hospital . Results Insulation was associated with a small increase in bedroom temperatures during the winter ( 0.5 � C ) and decreased relative humidity ( −2.3 % ) , despite energy consumption in insulated houses being 81 % of that in uninsulated houses . Bedroom temperatures were below 10 � C for 1.7 fewer hours each day in insulated homes than in uninsulated ones . These changes were associated with reduced odds in the insulated homes of fair or poor self rated health ( adjusted odds ratio 0.50 , 95 % confidence interval 0.38 to 0.68 ) , self reports of wheezing in the past three months ( 0.57 , 0.47 to 0.70 ) , self reports of children taking a day off school ( 0.49 , 0.31 to 0.80 ) , and self reports of adults taking a day off work ( 0.62 , 0.46 to 0.83 ) . Visits to general practitioners were less often reported by occupants of insulated homes ( 0.73 , 0.62 to 0.87 ) . Hospital admissions for respiratory conditions were also reduced ( 0.53 , 0.22 to 1.29 ) , but this reduction was not statistically significant ( P=0.16 ) . Conclusion Insulating existing houses led to a significantly warmer , drier indoor environment and result ed in improved self rated health , self reported wheezing , days off school and work , and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions Background Insecticide-treated bed nets ( ITN ) reduce malaria morbidity and mortality consistently in Africa , but their benefits have been less consistent in Asia . This study ’s objective was to evaluate the malaria protective efficacy of village-wide usage of ITN in Western Myanmar and estimate the cost-effectiveness of ITN compared with extending early diagnosis and treatment services . Methods A cluster-r and omized controlled trial was conducted in Rakhine State to assess the efficacy of ITNs in preventing malaria and anaemia in children and their secondary effects 
    Output:
    
There was fairly consistent evidence for the cost-effectiveness/favorable cost-benefit of removing indoor lead to prevent lead poisoning and sequelae , and retrofitting insulation to prevent lung disease .
But the value of assessing and improving home safety and providing smoke alarms to prevent injuries was more mixed and the economic evidence was inconclusive or insufficient for : home ventilation to prevent lung disease , installing heaters to prevent lung disease and regulating tap water temperatures to prevent scalding .
Conclusions This systematic review provides up date d evidence that several housing improvement interventions ( such as removing indoor lead and retrofitting insulation ) and also the provision of insecticide-treated bednets are cost-effective interventions .