哮喘联盟

   摘要
   背景：需要一些开展真实世界研究以确定临床实践中哮喘治疗的成本效益。
   目的：研究旨在比较英国（UK）和美国（US）使用超细颗粒微粒吸入糖皮质激素（ICS）与标准尺寸大小颗粒微粒ICS的成本效益。
   方法：这些回顾性、匹配队列分析使用大型电子数据库研究英国（12岁；n = 1730）和美国（12-80年；n = 10312）哮喘患者的相关预后，患者使用超细倍氯米松或氟替卡松作为治疗哮喘的起始ICS药物。研究根据患者人口特征和1年基线期间的哮喘严重程度进行匹配，比较治疗1年后的哮喘控制和哮喘相关费用。
   结果：在英国和美国，哮喘控制风险域的调整比值相似，而超细ICS在这两个国家的总体控制比值（无住院治疗或口服类固醇的哮喘、无抗生素治疗下呼吸道感染、有限的缓解剂的使用）更大（英国比值比为1.23；95%可信区间（CI）1.01-1.50）。这两个国家超细颗粒微粒ICS组的哮喘相关年成本、调整基线显著降低（英国差额为£- 66（95% CI，-93至-37））。通过两项哮喘控制措施的成本效益分析发现，在英国，超细颗粒微粒ICS为首选治疗策略的概率为92%和98%（较标准尺寸颗粒ICS成本更低、更有效），美国概率为84%和100%。
   结论：在英国和美国，起始使用超细颗粒微粒ICS治疗哮喘较使用标准尺寸颗粒大小微粒ICS似乎是更优选的治疗方案（成本更低、更有效）。
 

 （苏欣 审校）
NPJ Prim Care Respir Med. 2014 Oct 9;24:14081. doi: 10.1038/npjpcrm.2014.81.

 

Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study.
 

Martin RJ1, Price D2, Roche N3, Israel E4, van Aalderen WM5, Grigg J6, Postma DS7, Guilbert TW8, Hillyer EV9, Burden A9, von Ziegenweidt J9, Colice G10.
 

ABSTRACT
BACKGROUND: Real-life studies are needed to determine the cost-effectiveness of asthma therapies in clinical practice.
AIM: To compare the cost-effectiveness of extrafine-particle inhaled corticosteroid (ICS) with standard size-particle ICS in the United Kingdom (UK) and United States (US).
METHODS:These retrospective matched cohort analyses used large electronic databases to study asthma-related outcomes for patients in the UK (12-60 years old; n=1730) and US (12-80 years; n=10,312) prescribed extrafine beclomethasone or fluticasone as their first ICS therapy for asthma. Patients were matched on demographic characteristics and asthma severity during 1 baseline year, and asthma control and asthma-related costs were compared during 1 outcome year.
RESULTS: In both the UK and US, adjusted odds of risk-domain asthma control were similar, whereas the odds of overall control (no hospitalisation or oral steroids for asthma, no antibiotics for lower respiratory infection, limited reliever use) were greater for extrafine ICS in both countries (UK odds ratio, 1.23; 95% confidence interval (CI), 1.01-1.50). Asthma-related annual costs, adjusted for baseline, were significantly lower for extrafine-particle ICS cohorts in both countries (UK difference, -£66 (95% CI,-93 to -37)). Cost-effectiveness analyses using the two measures of asthma control found 92 and 98% probabilities of extrafine-particle ICS being the preferred treatment strategy (less costly and more effective than standard size-particle ICS) in the UK, and 84 and 100% probabilities in the US.
CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US.
 

NPJ Prim Care Respir Med. 2014 Oct 9;24:14081. doi: 10.1038/npjpcrm.2014.81.