重度持续性过敏性哮喘患者温度控制层流治疗的经济分析
2016/05/31
摘要
简介：慢性哮喘是个体患者的沉重负担，影响他们的工作和生活质量，并且是国民医疗服务（NHS）的主要支出。温度控制层流（TLA）治疗为哮喘患者在BTS/SIGN步骤4/5提供一个无创的附加的治疗选择，现在临床研究已被证明可以提高过敏性哮喘控制较差的患者的生活质量。本研究的目的是量化TLA（airsonett AB）技术在英国作为标准哮喘疗法的一种补充的成本效益。
方法：利益的主要指标是使用TLA加常规护理与单独进行常规护理的情况下，患者生命质量年(QALY)花费的持续增加。使用TLA持续增加的费用是基于一个临床观察研究，这个研究是用NHS支出数据来监测治疗后病情加重的发病率。用于导出增量QALY数据的临床有效性，是基于一个随机双盲安慰剂对照临床试验，包括用哮喘状态相同的参与者。
结果:对于哮喘临床患者作为一个整体，增量成本效益比（ICER）是每获得一个生命质量年£8998，即国家卫生与保健研究所（NICE）的成本效益所使用的基准是£20 000 /QALY。敏感性分析表明，ICER值的范围从最不严重患者的£18 883/QALY到TLA显著的，即具有最严重哮喘且控制较差的人要节约成本并提高生活质量。
结论:根据我们的结果，airsonett TLA是一个治疗4/5阶段患者的成本有效的治疗选择。对于哮喘更严重且控制较差的高危人群来说，使用TLA治疗来减少发病住院率对NHS来说将是节省成本的。
（杨冬 审校）
BMJ Open Respir Res. 2016 Mar 23;3(1):e000117. doi: 10.1136/bmjresp-2015-000117. eCollection 2016.
Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma.
Brazier P1, Schauer U2, Hamelmann E3, Holmes S4, Pritchard C1, Warner JO5.
Author information
Abstract
INTRODUCTION:Chronic asthma is a significant burden for individual sufferers, adversely impacting their quality of working and social life, as well as being a major cost to the National Health Service (NHS). Temperature-controlled laminar airflow (TLA) therapy provides asthma patients at BTS/SIGN step 4/5 an add-on treatment option that is non-invasive and has been shown in clinical studies to improve quality of life for patients with poorly controlled allergic asthma. The objective of this study was to quantify the cost-effectiveness of TLA (Airsonett AB) technology as an add-on to standard asthma management drug therapy in the UK.
METHODS:The main performance measure of interest is the incremental cost per quality-adjusted life year (QALY) for patients using TLA in addition to usual care versus usual care alone. The incremental cost of TLA use is based on an observational clinical study monitoring the incidence of exacerbations with treatment valued using NHS cost data. The clinical effectiveness, used to derive the incremental QALY data, is based on a randomised double-blind placebo-controlled clinical trial comprising participants with an equivalent asthma condition.
RESULTS:For a clinical cohort of asthma patients as a whole, the incremental cost-effectiveness ratio (ICER) is £8998 per QALY gained, that is, within the £20 000/QALY cost-effectiveness benchmark used by the National Institute for Health and Care Excellence (NICE). Sensitivity analysis indicates that ICER values range from £18 883/QALY for the least severe patients through to TLA being dominant, that is, cost saving as well as improving quality of life, for individuals with the most severe and poorly controlled asthma.
CONCLUSIONS:Based on our results, Airsonett TLA is a cost-effective addition to treatment options for stage 4/5 patients. For high-risk individuals with more severe and less well controlled asthma, the use of TLA therapy to reduce incidence of hospitalisation would be a cost saving to the NHS.
KEYWORDS:Asthma; Health Economist
BMJ Open Respir Res. 2016 Mar 23;3(1):e000117. doi: 10.1136/bmjresp-2015-000117. eCollection 2016.
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传统草药hangekobokuto（半夏厚朴汤）对呼吸道疾病患者喉咙哽塞感的影响
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慢性阻塞性肺疾病与哮喘患者因切换装置吸入性错误：重要的健康和经济问题
