三联吸入器与双联吸入器治疗中至重度哮喘的成本效用比较
2021/12/24
摘要
背景：尽管使用吸入皮质类固醇和长效β-受体激动剂，仍有很大一部分哮喘患者无法控制。临床指南建议，在这些患者中，使用附加的长效毒菌碱拮抗剂(三联疗法)，和大剂量吸入皮质类固醇-长效β2受体激动剂(双重疗法)进行治疗。
目的:本研究的目的是评估三联疗法与双重疗法对严重哮喘患者的成本效用。
方法:建立了一个马尔科夫概率模型来估计哥伦比亚严重哮喘患者的成本和质量调整生命年(QALYs)。计算了整个生命周期的双重和三联治疗的总成本和QALYs。进行了多重敏感性分析。按愿意支付价值19 000美元评价了成本效益。
结果:该模型表明，与双重治疗相比，三联治疗每年每个患者的潜在收益为1.55 QALYs。我们观察到，与双重治疗相比，三联治疗的人均年折扣成本为304美元。在概率模型中，增量成本-效果比为196美元。在敏感性分析中，我们的基本案例结果对所有假设和参数的变化都是稳健的。
结论:我们的结果显示，在使用口服皮质类固醇或生物制剂之前，尤其是在资源有限的环境中，使用三联疗法可以作为替代方案使用。
Cost-utility of triple versus dual inhaler therapy in moderate to severe asthma
Buendia JA, Patino DG.
Abstract
BACKGROUND:An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (triple therapy) to treatment with high doses of inhaled corticosteroids-long-acting beta2-agonist (dual therapy).
OBJECTIVE:The purpose of this study was to assess the cost-effectiveness of triple therapy versus dual therapy for patients with severe asthma.
METHODS:A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of dual and triple therapy were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.
RESULTS:The model suggests a potential gain of 1.55 QALYs per patient per year on triple therapy with respect to dual therapy. We observed a difference of US$304 in discounted cost per person-year on triple therapy with respect to dual therapy. The incremental cost-effectiveness ratio was US$196 in the probabilistic model. In the sensitivity analysis, our base-case results were robust to variations in all assumptions and parameters.
CONCLUSIONS: In conclusion, triple therapy in patients with moderate-severe asthma was cost-effective. Using triple therapy emerges with our results as an alternative before using oral corticosteroids or biologics, especially in resource-limited settings.
背景：尽管使用吸入皮质类固醇和长效β-受体激动剂，仍有很大一部分哮喘患者无法控制。临床指南建议，在这些患者中，使用附加的长效毒菌碱拮抗剂(三联疗法)，和大剂量吸入皮质类固醇-长效β2受体激动剂(双重疗法)进行治疗。
目的:本研究的目的是评估三联疗法与双重疗法对严重哮喘患者的成本效用。
方法:建立了一个马尔科夫概率模型来估计哥伦比亚严重哮喘患者的成本和质量调整生命年(QALYs)。计算了整个生命周期的双重和三联治疗的总成本和QALYs。进行了多重敏感性分析。按愿意支付价值19 000美元评价了成本效益。
结果:该模型表明，与双重治疗相比，三联治疗每年每个患者的潜在收益为1.55 QALYs。我们观察到，与双重治疗相比，三联治疗的人均年折扣成本为304美元。在概率模型中，增量成本-效果比为196美元。在敏感性分析中，我们的基本案例结果对所有假设和参数的变化都是稳健的。
结论:我们的结果显示，在使用口服皮质类固醇或生物制剂之前，尤其是在资源有限的环境中，使用三联疗法可以作为替代方案使用。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（BMC Pulm Med, 2021, 21(1): 398.）
（BMC Pulm Med, 2021, 21(1): 398.）
Cost-utility of triple versus dual inhaler therapy in moderate to severe asthma
Buendia JA, Patino DG.
Abstract
BACKGROUND:An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (triple therapy) to treatment with high doses of inhaled corticosteroids-long-acting beta2-agonist (dual therapy).
OBJECTIVE:The purpose of this study was to assess the cost-effectiveness of triple therapy versus dual therapy for patients with severe asthma.
METHODS:A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of dual and triple therapy were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.
RESULTS:The model suggests a potential gain of 1.55 QALYs per patient per year on triple therapy with respect to dual therapy. We observed a difference of US$304 in discounted cost per person-year on triple therapy with respect to dual therapy. The incremental cost-effectiveness ratio was US$196 in the probabilistic model. In the sensitivity analysis, our base-case results were robust to variations in all assumptions and parameters.
CONCLUSIONS: In conclusion, triple therapy in patients with moderate-severe asthma was cost-effective. Using triple therapy emerges with our results as an alternative before using oral corticosteroids or biologics, especially in resource-limited settings.
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沙参叶挥发油对哮喘气道炎症的疗效和机制：网络药理学和体内研究
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Dupilumab单抗治疗未控制的中重度哮喘儿童
