Briggs A H, Bousquet J, Wallace M V, Busse W W, Clark T J H, Pedersen S E, Bateman E D
Public Health & Health Policy, University of Glasgow, Glasgow, UK.
Allergy. 2006 May;61(5):531-6. doi: 10.1111/j.1398-9995.2006.01038.x.
The Gaining Optimal Asthma ControL (GOAL) study has shown the superiority of a combination of salmeterol/fluticasone propionate (SFC) compared with fluticasone propionate alone (FP) in terms of improving guideline defined asthma control.
Clinical and economic data were taken from the GOAL study, supplemented with data on health related quality of life, in order to estimate the cost per quality adjusted life year (QALY) results for each of three strata (previously corticosteroid-free, low- and moderate-dose corticosteroid users). A series of statistical models of trial outcomes was used to construct cost effectiveness estimates across the strata of the multinational GOAL study including adjustment to the UK experience. Uncertainty was handled using the non-parametric bootstrap. Cost-effectiveness was compared with other treatments for chronic conditions.
Salmeterol/fluticasone propionate improved the proportion of patients achieving totally and well-controlled weeks resulting in a similar QALY gain across the three strata of GOAL. Additional costs of treatment were greatest in stratum 1 and least in stratum 3, with some of the costs offset by reduced health care resource use. Cost-effectiveness by stratum was 7600 pound (95% CI: 4800-10,700 pound) per QALY gained for stratum 3; 11,000 pound (8600-14,600 pound) per QALY gained for stratum 2; and 13,700 pound (11,000-18,300 pound) per QALY gained for stratum 1.
The GOAL study previously demonstrated the improvement in total control associated with the use of SFC compared with FP alone. This study suggests that this improvement in control is associated with cost-per-QALY figures that compare favourably with other uses of scarce health care resources.
获得最佳哮喘控制（GOAL）研究表明，与单用丙酸氟替卡松（FP）相比，沙美特罗/丙酸氟替卡松（SFC）联合使用在改善指南定义的哮喘控制方面具有优越性。
临床和经济数据取自GOAL研究，并补充了与健康相关的生活质量数据，以便估算三个分层（既往未使用皮质类固醇、低剂量和中等剂量皮质类固醇使用者）中每一层的每质量调整生命年（QALY）结果成本。使用一系列试验结果统计模型来构建跨国GOAL研究各分层的成本效益估计值，包括根据英国经验进行调整。采用非参数自助法处理不确定性。将成本效益与其他慢性病治疗方法进行比较。
沙美特罗/丙酸氟替卡松提高了实现完全和良好控制周数的患者比例，在GOAL研究的三个分层中带来了相似的QALY增加。治疗的额外成本在第1层最高，在第3层最低，部分成本因医疗资源使用减少而抵消。第3层每获得一个QALY的分层成本效益为7600英镑（95%CI：4800 - 10700英镑）；第2层每获得一个QALY为11000英镑（8600 - 14600英镑）；第1层每获得一个QALY为13700英镑（11000 - 18300英镑）。
GOAL研究先前证明，与单用FP相比，使用SFC可改善总体控制。本研究表明，这种控制方面的改善与每QALY成本数据相关，与稀缺医疗资源的其他用途相比具有优势。
