过敏性哮喘儿童使用屋尘螨过敏原免疫疗法的成本-效益分析
2022/09/20
摘要
背景：评估儿童过敏原免疫疗法（AIT）的成本-效益研究数量有限，但需要这方面的研究，来推动临床和决策的决定，如新干预措施的报销。在这项研究中，我们比较了皮下注射脱敏治疗（SCIT）和舌下免疫治疗（SLIT）片剂对患有屋尘螨（HDM）过敏性哮喘的儿童进行标准护理（SOC）治疗的成本效率。
方法：我们根据全球哮喘防治创议（GINA）的严重程度步骤建立了一个假设的马尔可夫模型，以6个月为一个周期，在10年的时间内比较这三种策略。SOC被用作参考，以计算增量成本效益比（ICER）。确定性和概率敏感性分析用于评估模型的不确定性。对其他情况进行了评估，以加强结果的表述。
结果：SCIT和SLIT片的ICER分别为1281欧元和7717欧元。葡萄牙的成本效益阈值为18482.80欧元；两种治疗方法都低于这个阈值。这些结果的主要贡献者是AIT对减少中度和重度恶化的影响和哮喘控制药物。在敏感性分析中，SCIT显示出比SLIT更高的成本效益概率。当把过敏性鼻炎作为合并症时，ICER值明显降低，特别是SCIT干预。
结论：对患有HDM驱动的过敏性哮喘的儿童来说，AIT具有成本效益，尤其是通过皮下途径给药时。成本高效益，特别是SCIT，可能会推动未来的政策决定和AIT处方习惯。AIT的依从性极大地影响了结果，突出了实施策略以提高依从率的价值。
Cost-effectiveness analysis of house dust mite allergen immunotherapy in children with allergic asthma.
Farraia, M., Paciência, I., Castro Mendes, F., Cavaleiro Rufo, J., H Shamji, M., Agache, I., & Moreira, A.
Abstract
BACKGROUND:Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are limited but needed to drive clinical and policy-making decisions such as reimbursement of new interventions. In this study, we compared the cost effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) tablets to the standard of care (SOC) treatment in children with house dust mite-driven (HDM) allergic asthma.
METHODS:We developed a hypothetical Markov model based on the Global Initiative for Asthma (GINA) severity steps to compare the three strategies over a 10-year horizon divided by cycles of 6 months. SOC was used as a reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were used to assess models' uncertainty. Other scenarios were evaluated to strengthen the presentation of results.
RESULTS:The ICER for SCIT and SLIT tablets was 1281€ and 7717€, respectively. The cost-effectiveness threshold for Portugal was 18,482.80€; both treatment approaches were below this limit. The major contributors to these results were the AIT effects on reducing moderate and severe exacerbations and asthma controller medication. In the sensitivity analysis, SCIT revealed a higher probability of cost-effectiveness than SLIT. When including allergic rhinitis as comorbidity, ICER values reduced markedly, especially for SCIT intervention.
CONCLUSION:AIT was cost effective in children with HDM-driven allergic asthma, especially when given by the subcutaneous route. The high probability of cost effectiveness, especially for SCIT, may drive future policy decisions and AIT-prescribing habits. AIT adherence greatly influenced the results highlighting the value of implementing strategies to promote adherence rates.
背景：评估儿童过敏原免疫疗法（AIT）的成本-效益研究数量有限，但需要这方面的研究，来推动临床和决策的决定，如新干预措施的报销。在这项研究中，我们比较了皮下注射脱敏治疗（SCIT）和舌下免疫治疗（SLIT）片剂对患有屋尘螨（HDM）过敏性哮喘的儿童进行标准护理（SOC）治疗的成本效率。
方法：我们根据全球哮喘防治创议（GINA）的严重程度步骤建立了一个假设的马尔可夫模型，以6个月为一个周期，在10年的时间内比较这三种策略。SOC被用作参考，以计算增量成本效益比（ICER）。确定性和概率敏感性分析用于评估模型的不确定性。对其他情况进行了评估，以加强结果的表述。
结果：SCIT和SLIT片的ICER分别为1281欧元和7717欧元。葡萄牙的成本效益阈值为18482.80欧元；两种治疗方法都低于这个阈值。这些结果的主要贡献者是AIT对减少中度和重度恶化的影响和哮喘控制药物。在敏感性分析中，SCIT显示出比SLIT更高的成本效益概率。当把过敏性鼻炎作为合并症时，ICER值明显降低，特别是SCIT干预。
结论：对患有HDM驱动的过敏性哮喘的儿童来说，AIT具有成本效益，尤其是通过皮下途径给药时。成本高效益，特别是SCIT，可能会推动未来的政策决定和AIT处方习惯。AIT的依从性极大地影响了结果，突出了实施策略以提高依从率的价值。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Allergy. 2022 May 9; DOI: 10.1111/all.15321)
(Allergy. 2022 May 9; DOI: 10.1111/all.15321)
Cost-effectiveness analysis of house dust mite allergen immunotherapy in children with allergic asthma.
Farraia, M., Paciência, I., Castro Mendes, F., Cavaleiro Rufo, J., H Shamji, M., Agache, I., & Moreira, A.
Abstract
BACKGROUND:Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are limited but needed to drive clinical and policy-making decisions such as reimbursement of new interventions. In this study, we compared the cost effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) tablets to the standard of care (SOC) treatment in children with house dust mite-driven (HDM) allergic asthma.
METHODS:We developed a hypothetical Markov model based on the Global Initiative for Asthma (GINA) severity steps to compare the three strategies over a 10-year horizon divided by cycles of 6 months. SOC was used as a reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were used to assess models' uncertainty. Other scenarios were evaluated to strengthen the presentation of results.
RESULTS:The ICER for SCIT and SLIT tablets was 1281€ and 7717€, respectively. The cost-effectiveness threshold for Portugal was 18,482.80€; both treatment approaches were below this limit. The major contributors to these results were the AIT effects on reducing moderate and severe exacerbations and asthma controller medication. In the sensitivity analysis, SCIT revealed a higher probability of cost-effectiveness than SLIT. When including allergic rhinitis as comorbidity, ICER values reduced markedly, especially for SCIT intervention.
CONCLUSION:AIT was cost effective in children with HDM-driven allergic asthma, especially when given by the subcutaneous route. The high probability of cost effectiveness, especially for SCIT, may drive future policy decisions and AIT-prescribing habits. AIT adherence greatly influenced the results highlighting the value of implementing strategies to promote adherence rates.
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