Gendo Karna, Sullivan Sean D, Lozano Paula, Finkelstein Jonathan A, Fuhlbrigge Anne, Weiss Kevin B
School of Pharmacy, University of Washington, Seattle, Washington, USA.
Ann Allergy Asthma Immunol. 2003 Sep;91(3):251-7. doi: 10.1016/S1081-1206(10)63526-0.
In 1998, the economic burden of asthma in the United States was estimated to be 12.7 billion dollars. Yet few studies have examined the relationship between the total costs of asthma-related care and measures of asthma morbidity. Understanding the relationship between total costs of asthma-related care and morbidity can assist in designing the most cost-effective asthma care strategies to improve patient outcomes and minimize total costs.
To investigate correlates of asthma costs for children with mild-to-moderate persistent asthma and, specifically, to characterize how closely the percentage of predicted forced expiratory volume in 1 second (FEV1) and symptom days were correlated with costs of illness.
A total of 638 parents and children with mild-to-moderate persistent asthma in 4 managed care delivery systems in 3 different US geographic regions were enrolled. Symptom burden and annual resource utilization were determined from reports of physician visits, hospitalizations, emergency department visits, medication use, and parental missed workdays. Spirometry was conducted on children who were 5 years and older. To characterize the relationship between symptom days and the percentage of predicted FEV1 with costs, we specified a multivariate regression model.
The median total annual asthma-related cost for the group was 564 dollars (interquartile range [IQR], 131 dollars-1602 dollars). Indirect costs represented 54.6% of total costs. Medicines accounted for 52.6% of direct costs. The mean percentage of predicted FEV1 was 101.6% (range, 39.3%-183.5%; IQR, 91.6%-111.3%), with 91.4% of patients with a percentage of predicted FEV1 of more than 80%. Based on multivariate modeling, increasing asthma severity, use of peak expiratory flow rate meters, younger age, low-income status and nonwhite race, and longer duration of asthma were significantly associated with increasing cost. Symptom days (P < 0.001) predicted annual costs better than percentage of predicted FEV1 (P < 0.16) in this group of children.
For the large number of children with mild-to-moderate persistent asthma and normal or near-normal lung function, symptom days are predictive of health care costs. For these insured children receiving care from 3 large managed care providers, low-income status and nonwhite race were the strongest correlates for increased asthma-related costs.
1998年，美国哮喘的经济负担估计为127亿美元。然而，很少有研究探讨哮喘相关护理的总成本与哮喘发病率指标之间的关系。了解哮喘相关护理总成本与发病率之间的关系有助于设计最具成本效益的哮喘护理策略，以改善患者预后并使总成本降至最低。
调查轻度至中度持续性哮喘患儿哮喘成本的相关因素，具体而言，描述一秒用力呼气容积（FEV1）预测值百分比和症状天数与疾病成本的密切程度。
在美国3个不同地理区域的4个管理式医疗服务系统中，共招募了638名患有轻度至中度持续性哮喘的家长和儿童。根据医生就诊、住院、急诊就诊、药物使用和家长误工天数的报告确定症状负担和年度资源利用情况。对5岁及以上的儿童进行肺功能测定。为了描述症状天数和FEV1预测值百分比与成本之间的关系，我们指定了一个多元回归模型。
该组患儿每年哮喘相关总成本的中位数为564美元（四分位间距[IQR]，131美元 - 1602美元）。间接成本占总成本的54.6%。药物占直接成本的52.6%。FEV1预测值的平均百分比为101.6%（范围，39.3% - 183.5%；IQR，91.6% - 111.3%），91.4%的患者FEV1预测值百分比超过80%。基于多变量建模，哮喘严重程度增加、使用呼气峰值流速仪、年龄较小、低收入状态和非白人种族以及哮喘病程较长与成本增加显著相关。在这组儿童中，症状天数（P < 0.001）比FEV1预测值百分比（P < 0.16）能更好地预测年度成本。
对于大量轻度至中度持续性哮喘且肺功能正常或接近正常的儿童，症状天数可预测医疗保健成本。对于这些从3家大型管理式医疗服务提供者处接受护理的参保儿童，低收入状态和非白人种族是哮喘相关成本增加的最主要相关因素。
