Schermer Tjard R, Thoonen Bart P, van den Boom Guido, Akkermans Reinier P, Grol Richard P, Folgering Hans T, van Weel Chris, van Schayck Constant P
Department of General Practice/Family Medicine, Center for Quality of Care Research, and University Lungcentre Dekkerswald, University Medical Center St. Radboud, Nijmegen, The Netherlands.
Am J Respir Crit Care Med. 2002 Oct 15;166(8):1062-72. doi: 10.1164/rccm.2105116.
In this randomized controlled economic evaluation we compared guided asthma self-management with usual asthma care according to guidelines for Dutch family physicians. Nineteen family practices were randomized, and 193 adults with stable asthma (98 self-management, 95 usual care) were included and monitored for 2 years. We hypothesized that introducing self-management would not compromise asthma control and cost would be equal to or lower than in usual care. Patient-specific cost data were collected, preference-based utilities were assessed, and incremental cost per quality-adjusted life year (QALY) and successfully treated week gained was calculated. Self-management patients gained 0.039 QALY (95% confidence interval [CI], 0.003 to 0.075) and experienced 81 (95% CI, 78 to 84) successfully treated weeks in 2 years' time; the corresponding figures for usual care were 0.024 (95% CI, -0.022 to 0.071) and 75 (95% CI, 72 to 78). Total costs were 1,084 euros(95% CI, 938 to 1,228) for self-management and 1,097 euros (95% CI, 933 to 1,260) for usual care. Self-management patients consumed 1,680 (95% CI, 1,538 to 1,822) puffs of budesonide, usual care patients 1,897 (95% CI, 1,679 to 2,115). Mean productivity cost due to limited activity days was 213 euros lower among self-management patients. When all costs were included, self-management was cost-effective on all outcomes. The probability that self-management was cost-effective relative to usual care in terms of QALYs was 52%. We conclude that guided self-management is a safe and efficient alternative approach compared with asthma treatment usually provided in Dutch primary care.
在这项随机对照经济评估中，我们根据荷兰家庭医生指南，将哮喘自我管理指导与常规哮喘护理进行了比较。19个家庭诊所被随机分组，193名稳定期哮喘成人（98名自我管理组，95名常规护理组）被纳入并监测2年。我们假设引入自我管理不会损害哮喘控制，且成本将等于或低于常规护理。收集了患者特定的成本数据，评估了基于偏好的效用，并计算了每质量调整生命年（QALY）和每成功治疗周的增量成本。自我管理组患者在2年内获得了0.039个QALY（95%置信区间[CI]，0.003至0.075），经历了81（95%CI，78至84）个成功治疗周；常规护理组的相应数字为0.024（95%CI，-0.022至0.071）和75（95%CI，72至78）。自我管理组的总成本为1084欧元（95%CI，938至1228），常规护理组为1097欧元（95%CI，933至1260）。自我管理组患者使用了1680（95%CI，1538至1822）吸布地奈德，常规护理组患者使用了1897（95%CI，1679至2115）吸。自我管理组患者因活动天数受限导致的平均生产力成本低213欧元。当纳入所有成本时，自我管理在所有结果上都具有成本效益。自我管理相对于常规护理在QALYs方面具有成本效益的概率为52%。我们得出结论，与荷兰初级保健中通常提供的哮喘治疗相比，自我管理指导是一种安全有效的替代方法。
