Reed Shelby D, Lee Todd A, McCrory Douglas C
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA.
Pharmacoeconomics. 2004;22(6):345-61. doi: 10.2165/00019053-200422060-00002.
Although a large number of economic analyses of allergic rhinitis have been published, there are relatively few empirically based studies, particularly outside the US. The majority of these analyses can be classified as burden-of-illness studies. Most estimates of the annual cost of allergic rhinitis range from dollars US 2-5 billion (2003 values). The wide range of estimates can be attributed to differences in identifying patients with allergic rhinitis, differences in cost assignment, limitations associated with available data and difficulties in assigning indirect costs (associated with reduced productivity) of allergic rhinitis. Approximately one-third of burden-of-illness studies include direct and indirect costs of allergic rhinitis, about one-third focus on direct costs only, and the remaining one-third focus exclusively on indirect costs due to reduced productivity. Indirect costs attributable to allergic rhinitis were higher in studies only estimating indirect costs (dollars US 5.5-9.7 billion) than in those estimating both direct and indirect costs (dollars US 1.7-4.3 billion). Although there are many economic evaluations of allergic rhinitis treatments in the published medical literature, very few represent formal cost-effectiveness evaluations that compare the incremental costs and benefits of alternative treatment strategies. Those that are incremental cost-effectiveness analyses have several limitations, including small samples, short study periods and the lack of a standardized measure of effectiveness. To date, the medical literature is lacking a comprehensive economic evaluation of general treatment strategies for allergic rhinitis. In undertaking such an analysis, serious consideration must be given to the study population of interest, the choice of appropriate comparators, the perspective from which the analysis is conducted, the target audience, the changing healthcare marketplace and the selection of a measure of effectiveness that incorporates both positive and negative aspects of treatments for allergic rhinitis. Future work would benefit from the development of a consensus on a summary measure of effectiveness that could be used in cost-effectiveness analyses of therapies for allergic rhinitis as well as additional empirical work to measure the association between severity of disease and its impact on worker productivity.
尽管已经发表了大量关于变应性鼻炎的经济分析，但基于实证的研究相对较少，尤其是在美国以外的地区。这些分析大多可归类为疾病负担研究。变应性鼻炎的年度成本大多数估计在20亿至50亿美元之间（2003年数值）。估计范围广泛可归因于变应性鼻炎患者识别的差异、成本分配的差异、可用数据的局限性以及变应性鼻炎间接成本（与生产力降低相关）分配的困难。大约三分之一的疾病负担研究包括变应性鼻炎的直接和间接成本，约三分之一仅关注直接成本，其余三分之一仅关注因生产力降低导致的间接成本。在仅估计间接成本的研究中（55亿至97亿美元），变应性鼻炎所致的间接成本高于同时估计直接和间接成本的研究（17亿至43亿美元）。尽管在已发表的医学文献中有许多关于变应性鼻炎治疗的经济评估，但很少有代表正式成本效益评估的，即比较替代治疗策略的增量成本和效益。那些增量成本效益分析有几个局限性，包括样本量小、研究周期短以及缺乏标准化的疗效衡量指标。迄今为止，医学文献中缺乏对变应性鼻炎一般治疗策略的全面经济评估。在进行这样的分析时，必须认真考虑感兴趣的研究人群、适当对照的选择、分析所采用的视角、目标受众、不断变化的医疗市场以及纳入变应性鼻炎治疗的积极和消极方面的疗效衡量指标的选择。未来的工作将受益于就可用于变应性鼻炎治疗成本效益分析的综合疗效衡量指标达成共识，以及开展更多实证工作来衡量疾病严重程度与其对工人生产力影响之间的关联。
