哮喘联盟

   摘要
   背景：初级 (例如在出生前开始) 预防，例如通过单层面方法(UF) 解决一个或通过多层面方法(MF) 解决至少两个环境暴露因素，可使很多儿童在其一生中维持无哮喘获益。本文采用决策分析体系评估了荷兰儿童初级预防项目的成本-效益。
   方法：采用决策分析树模型分析卫生保健费用与哮喘病例的预防情况，并比较两种UF与三种MF 常规护理(UC) 项目对儿童哮喘的初级预防作用。通过增量成本-效益比和净货币获益对项目进行评价。采用信息-价值分析评价决策和参数的不确定性。
   结果：当前的UC和其中一种MF项目较其他项目具有主导优势。与UC相比，MF最节省成本并且也最有效，增量成本-效益比为8,209.20(欧元)/预防1次额外哮喘病例。减少不确定性完整信息的最低价值为291.6M (欧元)。成本-效益阈值中绝大多数的不确定性归因于低风险儿童的概率和成本估计。
   结论：本研究支持在儿童哮喘初级预防中，结构性项目同时解决房尘螨、宠物毛屑、环境烟草和母乳喂养暴露的可行性，并较UC更具有成本效益，可作为后者的替代选择。
 

（林江涛 审校）
Eur J Health Econ. 2013 Oct 6. [Epub ahead of print]


 

Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model.
 

Ramos GF, van Asselt AD, Kuiper S, Severens JL, Maas T, Dompeling E, Knottnerus JA, van Schayck OC.
 

ABSTRACT
BACKGROUND: Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework.
METHODS: A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses.
RESULTS: The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of <euro>8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was <euro>291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children.
CONCLUSION: This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.
 

Eur J Health Econ. 2013 Oct 6. [Epub ahead of print]