规律使用口服糖皮质激素治疗的哮喘患者的医疗资源利用与成本 – 一项瑞典观察性队列研究（PACEHR）
2018/11/13
摘要
背景：难以控制的重症哮喘患者可规律口服皮质类固醇(OCS)治疗。本研究调查了规律口服糖皮质激素的瑞典哮喘患者的医疗资源利用与成本。
方法：初级保健医疗记录的数据与瑞典国家卫生登记处的数据相关联。2007 - 2009年期间(指数日期)，在因阻塞性肺部疾病而有18年药物摄入史的患者和曾诊断过哮喘的患者中，根据观察周期12个月内摄入OCS的剂量进行分类:规律服用OCS≥5毫克/天;按需服用OCS每日少于5毫克;或未服用OCS。计算与哮喘和与OCS使用相关的医疗资源利用与成本。
结果：共纳入哮喘患者15437例(平均年龄47.8岁，女性62.6%)，其中223例(1.44%)为规律使用OCS的患者，3054例(19.7%)为按需使用，12160例(78.7%)未服用OCS。与其他组相比，规律使用OCS的患者较年长，且多为女性，肺功能较差，血嗜酸性粒细胞较高，合并症更多。年龄调整后的年度总卫生保健费用，规律口服OCS的患者(€5615)是未服用OCS患者(€1980)的三倍，是规律口服OCS组的两倍(€2948)。未服用OCS组和按需服用OCS组的主要医疗成本花销在于初级医疗咨询，而规律服用OCS组的主要医疗成本花销是住院费用。与哮喘相关的费用占全部三组总费用的10-12%。
结论：在瑞典进行的这项真实世界哮喘研究中，规律服用OCS的患者每年的医疗资源投入成本是没有服用OCS患者的三倍，提示规律服用OCS治疗的哮喘患者承担巨大的的经济和医疗负担。
Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)
Janson C, Lisspers K, et al. Respir Res. 2018 Sep 3
Abstract
BACKGROUND：Patients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients.
METHODS：Primary care medical records data were linked to data from Swedish national health registries.Patients ≥18 years with a drug claim for obstructive pulmonary diseases during 2007–2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months’ post index period: regular OCS equals ≥5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated.
RESULTS：A total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10–12% of the total cost in all three groups.
CONCLUSION：In this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.
背景：难以控制的重症哮喘患者可规律口服皮质类固醇(OCS)治疗。本研究调查了规律口服糖皮质激素的瑞典哮喘患者的医疗资源利用与成本。
方法：初级保健医疗记录的数据与瑞典国家卫生登记处的数据相关联。2007 - 2009年期间(指数日期)，在因阻塞性肺部疾病而有18年药物摄入史的患者和曾诊断过哮喘的患者中，根据观察周期12个月内摄入OCS的剂量进行分类:规律服用OCS≥5毫克/天;按需服用OCS每日少于5毫克;或未服用OCS。计算与哮喘和与OCS使用相关的医疗资源利用与成本。
结果：共纳入哮喘患者15437例(平均年龄47.8岁，女性62.6%)，其中223例(1.44%)为规律使用OCS的患者，3054例(19.7%)为按需使用，12160例(78.7%)未服用OCS。与其他组相比，规律使用OCS的患者较年长，且多为女性，肺功能较差，血嗜酸性粒细胞较高，合并症更多。年龄调整后的年度总卫生保健费用，规律口服OCS的患者(€5615)是未服用OCS患者(€1980)的三倍，是规律口服OCS组的两倍(€2948)。未服用OCS组和按需服用OCS组的主要医疗成本花销在于初级医疗咨询，而规律服用OCS组的主要医疗成本花销是住院费用。与哮喘相关的费用占全部三组总费用的10-12%。
结论：在瑞典进行的这项真实世界哮喘研究中，规律服用OCS的患者每年的医疗资源投入成本是没有服用OCS患者的三倍，提示规律服用OCS治疗的哮喘患者承担巨大的的经济和医疗负担。
（复旦大学附属中山医院呼吸与危重症医学科 魏婷婷 摘译 毕晶 审校）
（Respir Res. 2018 Sep 3）
（Respir Res. 2018 Sep 3）
Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)
Janson C, Lisspers K, et al. Respir Res. 2018 Sep 3
Abstract
BACKGROUND：Patients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients.
METHODS：Primary care medical records data were linked to data from Swedish national health registries.Patients ≥18 years with a drug claim for obstructive pulmonary diseases during 2007–2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months’ post index period: regular OCS equals ≥5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated.
RESULTS：A total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10–12% of the total cost in all three groups.
CONCLUSION：In this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.
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IL-5单抗在轻度哮喘中可改变鼻病毒诱导的巨噬细胞、B细胞及中性粒细胞反应(MATERIAL研究): 一项安慰剂对照、双
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严重嗜酸性粒细胞性哮喘患者的抗IL-5治疗 - 临床疗效及治疗反应标准
