Plaza Vicente, Cobos Albert, Ignacio-García José M, Molina Jesús, Bergoñón Salvador, García-Alonso Fernando, Espinosa Cristina
Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain.
Med Clin (Barc). 2005 Feb 19;124(6):201-6. doi: 10.1157/13071758.
To assess the cost-effectiveness of an intervention based on the Global INitiative for Asthma (GINA) recommendations as compared to usual care.
Pragmatic, cluster-randomised trial. Ten pneumologists and 10 general practitioners were randomised to an intervention or control group, recruiting 98 and 100 asthma patients, respectively. The intervention consisted of an education program and a clinical decision support system (CDSS) providing recommendations based on the GINA. The control group was characterized by usual care. Effectiveness was assessed by the health related quality of life as measured by the St. George's Respiratory Questionnaire (SGRQ). Costs were computed from the resource consumption recorded during a 12 months follow-up period, and the cost-effectiveness of the intervention was investigated in an incremental analysis.
The intervention effect on the SGRQ total score was estimated as a 6.8 point reduction (95% confidence interval, 2.5-11.1; p = 0.0021), and a significant improvement in the SGRQ subscores and in the symptoms-free periods were also observed. From the social perspective, the mean total costs showed savings of -1,022 Euros (95% confidence interval, -2,165 to 122; p = 0.0795) in intervention group as compared to usual care. The incremental analysis confirmed that the intervention was cost-effective.
The implementation of an asthma management program based in GINA recommendations improved the patient's health related quality of life and was cost-effective as compared to usual care.
评估基于全球哮喘防治创议（GINA）建议的干预措施与常规治疗相比的成本效益。
实用型整群随机试验。10名肺病科医生和10名全科医生被随机分为干预组或对照组，分别招募了98名和100名哮喘患者。干预措施包括一个教育项目和一个基于GINA提供建议的临床决策支持系统（CDSS）。对照组采用常规治疗。通过圣乔治呼吸问卷（SGRQ）测量的健康相关生活质量来评估有效性。根据12个月随访期记录的资源消耗计算成本，并在增量分析中研究干预措施的成本效益。
干预措施对SGRQ总分的影响估计为降低6.8分（95%置信区间，2.5 - 11.1；p = 0.0021），同时还观察到SGRQ子分数和无症状期有显著改善。从社会角度看，与常规治疗相比，干预组的平均总成本节省了 -1,022欧元（95%置信区间，-2,165至122；p = 0.0795）。增量分析证实该干预措施具有成本效益。
实施基于GINA建议的哮喘管理项目可改善患者的健康相关生活质量，与常规治疗相比具有成本效益。
