Kauppinen R, Vilkka V, Sintonen H, Klaukka T, Tukiainen H
South Karelia Central Hospital, Department of Respiratory Diseases, Lappeenranta, Finland.
Respir Med. 2001 Jan;95(1):56-63. doi: 10.1053/rmed.2000.0971.
The cost-effectiveness of intensive patient education of guided asthma self-management given during the first treatment year was evaluated after 5 years of follow-up. Consecutive, newly-diagnosed asthmatics (n = 162, age 18-76 years) were randomized for intensive (80 patients) vs. conventional patient education. Effectiveness was evaluated in terms of lung functions, airway hyperresponsiveness (PD15), and quality of life as measured by the generic 15D and disease-specific St. George's Respiratory Questionnaire (SGRQ). Total treatment costs were also estimated. All patients had anti-inflammatory treatment from the beginning. Sixty-four intervention group (IG) patients and 70 control group (CG) patients were evaluated after 5 years. Forced expiratory volume in 1 sec (FEV1) improved only in the IG, and only during the first treatment year. However, PD15 improved throughout the follow-up. The unscheduled healthcare costs were significantly higher in the CG than in the IG (P = 0.04) and the relative risk for sickness days due to asthma was lower in the IG than in the CG, odds ratio 0.33 (95% CI 0.28; 0.40). However, because there was no significant difference between the groups in any outcome variable or in total costs at 5 years, the incremental cost-effectiveness ratio could not be calculated. The first year intervention had only a short-term beneficial treatment effect, which the CG could catch up during the two last follow-up years, except in FEV1. The peak expiratory flow (PEF)-based self-management had no advantage over the symptom-based self-management. However, the intervention had a consistent tendency of being less costly in the long-run. It is possible to conclude tentatively that regular effective medical treatment and control visits during the first treatment year is at least as important for the long-term treatment result as intensive patient education.
在随访5年后，对首次治疗年度内进行的强化患者教育指导下的哮喘自我管理的成本效益进行了评估。连续纳入新诊断的哮喘患者（n = 162，年龄18 - 76岁），随机分为强化患者教育组（80例）和常规患者教育组。从肺功能、气道高反应性（PD15）以及通过通用的15D和疾病特异性的圣乔治呼吸问卷（SGRQ）测量的生活质量方面评估有效性。还估算了总治疗成本。所有患者从一开始就接受抗炎治疗。5年后对64例干预组（IG）患者和70例对照组（CG）患者进行了评估。1秒用力呼气容积（FEV1）仅在干预组中有所改善，且仅在首次治疗年度内。然而，PD15在整个随访期间均有改善。对照组的非计划医疗保健成本显著高于干预组（P = 0.04），且干预组因哮喘导致的病假相对风险低于对照组，比值比为0.33（95%CI 0.28；0.40）。然而，由于两组在任何结局变量或5年总费用方面均无显著差异，因此无法计算增量成本效益比。第一年的干预仅产生了短期有益的治疗效果，除FEV1外，对照组在最后两年的随访中能够赶上。基于呼气峰值流速（PEF）的自我管理并不优于基于症状的自我管理。然而，从长远来看，干预组有持续的成本较低的趋势。初步可以得出结论，在首次治疗年度进行定期有效的药物治疗和控制访视对于长期治疗结果至少与强化患者教育同样重要。
