Lane Stephen, Molina Jesus, Plusa Tadeusz
Respiratory Medicine & Allergy, Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland.
Respir Med. 2006 Mar;100(3):434-50. doi: 10.1016/j.rmed.2005.06.012. Epub 2005 Aug 11.
Asthma is a common chronic condition that places substantial burden on patients and healthcare services. Despite the standards of asthma control that international guidelines recommend should be achieved, many patients continue to suffer sub-optimal control of symptoms and experience exacerbations (acute asthma attacks). In addition to being associated with reduced quality of life, asthma exacerbations are a key cost driver in asthma management. Routine clinical practice for the management of asthma exacerbations varies in different healthcare systems, so healthcare providers require local costs to be able to assess the value of therapies that reduce the frequency and severity of exacerbations. This prospective study, conducted in a total of 15 countries, assessed the local cost of asthma exacerbations managed in either primary or secondary care. Healthcare resources used were costed using actual values appropriate to each country in local currency and in Euros. Results are presented for exacerbations managed in primary care in Brazil, Bulgaria, Croatia, Czech Republic, Hungary, Poland, Russia, Slovakia, Slovenia, Spain and Ukraine, and in secondary care in Croatia, Denmark, Ireland, Latvia, Norway, Poland, Russia, Slovakia, Slovenia and Spain. Multiple regression analysis of the 2052 exacerbations included in the economic analysis showed that the cost of exacerbations was significantly affected by country (P<0.0001). Mean costs were significantly higher in secondary care (euro 1349) than primary care (euro 445, P=0.0003). Age was a significant variable (P=0.0002), though the effect showed an interaction with care type (P<0.0001). As severity of exacerbation increased, so did secondary care costs, though primary care costs remained essentially constant. In conclusion, the study showed that asthma exacerbations are costly to manage, suggesting that therapies able to increase asthma control and reduce the frequency or severity of exacerbations may bring economic benefits, as well as improved quality of life.
哮喘是一种常见的慢性疾病，给患者和医疗服务带来了沉重负担。尽管国际指南推荐应达到哮喘控制标准，但许多患者的症状仍未得到最佳控制，且经历病情加重（急性哮喘发作）。除了与生活质量下降相关外，哮喘病情加重是哮喘管理中的一个关键成本驱动因素。不同医疗体系中，哮喘病情加重的常规临床管理方法各不相同，因此医疗服务提供者需要了解当地成本，以便评估能降低病情加重频率和严重程度的治疗方法的价值。这项前瞻性研究在总共15个国家开展，评估了在初级或二级护理中管理哮喘病情加重的当地成本。所使用的医疗资源根据每个国家当地货币和欧元的实际价值进行成本核算。文中给出了在巴西、保加利亚、克罗地亚、捷克共和国、匈牙利、波兰、俄罗斯、斯洛伐克、斯洛文尼亚、西班牙和乌克兰的初级护理中以及在克罗地亚、丹麦、爱尔兰、拉脱维亚、挪威、波兰、俄罗斯、斯洛伐克、斯洛文尼亚和西班牙的二级护理中管理病情加重的结果。对经济分析中纳入的2052例病情加重进行的多元回归分析表明，病情加重的成本受国家显著影响（P<0.0001）。二级护理的平均成本（1349欧元）显著高于初级护理（445欧元，P=0.0003）。年龄是一个显著变量（P=0.0002），不过其影响显示出与护理类型存在交互作用（P<0.0001）。随着病情加重程度的增加，二级护理成本也增加，而初级护理成本基本保持不变。总之，该研究表明，管理哮喘病情加重成本高昂，这表明能够提高哮喘控制水平并降低病情加重频率或严重程度的治疗方法可能带来经济效益以及生活质量的改善。
