Jönsson Bengt, Berggren Fredrik, Svensson Klas, O'Byrne Paul M
Centre for Health Economics, Stockholm School of Economics, Box 6501 Stockholm 11383, Sweden.
Respir Med. 2004 Nov;98(11):1146-54. doi: 10.1016/j.rmed.2004.04.005.
Patients with mild asthma may benefit from increasing their inhaled corticosteroid dose, adding a long-acting beta2-agonist, or both. This study assessed the cost-effectiveness of these options. Patients aged > or = 12 years with mild-to-moderate persistent asthma (n = 1272) were randomised to twice-daily, double-blind treatment with budesonide 100 microg, budesonide 100 microg plus formoterol 4.5 microg, budesonide 200 microg, or budesonide 200 microg plus formoterol 4.5 microg for 12 months. Clinical variables included lung function, number of symptom-free days and number of severe exacerbations. Data on medication use, hospitalisation, visits to health professionals and time off work due to asthma were combined with Swedish unit cost data (1999) to estimate the mean annual cost per patient. Budesonide 200 microg plus formoterol 4.5 microg had the greatest efficacy and effectiveness. Budesonide 200 microg plus formoterol 4.5 microg was both more effective and less costly than budesonide 100 microg plus formoterol 4.5 microg, so a cost-effectiveness ratio was not calculated for this comparison. The cost-effectiveness ratio for budesonide 200 microg plus formoterol 4.5 microg compared with budesonide 200 microg alone was SEK 21 per symptom-free days gained. The combination of budesonide and formoterol in mild-to-moderate persistent asthma improved effectiveness at modest additional cost.
轻度哮喘患者增加吸入性糖皮质激素剂量、添加长效β2受体激动剂或两者并用可能有益。本研究评估了这些方案的成本效益。年龄≥12岁的轻至中度持续性哮喘患者（n = 1272）被随机分为每日两次接受布地奈德100微克、布地奈德100微克加福莫特罗4.5微克、布地奈德200微克或布地奈德200微克加福莫特罗4.5微克的双盲治疗，为期12个月。临床变量包括肺功能、无症状天数和严重加重发作次数。将药物使用、住院、就诊于医疗专业人员以及因哮喘误工时间的数据与瑞典单位成本数据（1999年）相结合，以估算每位患者的年均成本。布地奈德200微克加福莫特罗4.5微克具有最大的疗效和有效性。布地奈德200微克加福莫特罗4.5微克比布地奈德100微克加福莫特罗4.5微克更有效且成本更低，因此未计算该比较的成本效益比。布地奈德200微克加福莫特罗4.5微克与单独使用布地奈德200微克相比，每增加一个无症状天数的成本效益比为21瑞典克朗。在轻至中度持续性哮喘中，布地奈德与福莫特罗联用在适度增加成本的情况下提高了有效性。
