Dal Negro Roberto, Piskorz Peter, Vives Roberto, Guilera Magda, Sazonov Kocevar Vasilisa, Badia Xavier
Lung Department, Bussolengo General Hospital, Verona, Italy.
Pharmacoeconomics. 2007;25(8):665-76. doi: 10.2165/00019053-200725080-00004.
To evaluate the healthcare resource use and costs associated with adding montelukast to therapy in patients with mild to moderate persistent asthma and co-morbid seasonal allergic rhinitis whose asthma is inadequately controlled by their current asthma therapy.
A multicentre, pre-post retrospective cohort study was conducted in three European countries (Italy, Poland and Spain). Consecutive patients who were receiving inhaled corticosteroid therapy (monotherapy or combination therapy with long-acting beta(2)-adrenoceptor agonists) and who started concomitant treatment with montelukast between January 1999 and December 2002 were identified from clinical charts. Asthma/seasonal allergic rhinitis-related concomitant medications and asthma-related outpatient care, ED visits and hospitalisations for the periods 12 months before and 12 months after montelukast initiation were recorded from patient charts and combined with country-specific published unit costs (adjusted to 2004 values). The analysis was performed from a third-party-payer perspective and thus direct healthcare resource utilisation due to asthma/seasonal allergic rhinitis and associated costs for each country were estimated.
A total of 98 physicians provided data for 696 asthmatic patients with seasonal allergic rhinitis (Italy: n = 158; Poland: n = 334; and Spain: n = 204). The mean age of patients was 32.7 years, 57.5% were female and patients had asthma that was considered either mild-persistent (54.5%) or moderate-persistent (45.5%) according to the Global Initiative for Asthma classifications. The introduction of montelukast (10 mg/day daily cost range euro0.8-1.68) was associated with increases in the total annual mean healthcare cost per patient of 11.9%, 60.4% and 5.5% for Italy, Poland and Spain, respectively. However, mean annual costs for asthma-related outpatient care, ED visits and hospitalisations dropped significantly in all three countries (Italy: from euro805.00 to euro281.60 [p < 0.01]; Poland: from euro127.10 to euro99.00 [p < 0.01]; and Spain: from euro463.40 to euro119.70 [p < 0.01]).
The addition of montelukast to therapy in patients with mild to moderate asthma and concomitant seasonal allergic rhinitis whose asthma was inadequately controlled by current asthma therapy significantly reduced the use of concomitant asthma-allergy medications, ED visits, outpatient care visits and hospitalisation. The total direct healthcare cost obtained after the addition of montelukast increased only as a result of the montelukast treatment cost.
评估在轻度至中度持续性哮喘且合并季节性过敏性鼻炎、当前哮喘治疗未充分控制哮喘的患者中，添加孟鲁司特进行治疗所涉及的医疗资源使用情况及成本。
在三个欧洲国家（意大利、波兰和西班牙）开展了一项多中心、前后对照的回顾性队列研究。从临床病历中识别出连续接受吸入性糖皮质激素治疗（单药治疗或与长效β₂肾上腺素受体激动剂联合治疗）且在1999年1月至2002年12月期间开始联合使用孟鲁司特治疗的患者。从患者病历中记录孟鲁司特开始使用前12个月和开始使用后12个月期间与哮喘/季节性过敏性鼻炎相关的联合用药以及与哮喘相关的门诊护理、急诊就诊和住院情况，并结合各国公布的特定单位成本（调整至2004年的值）。分析是从第三方支付者的角度进行的，因此估算了每个国家因哮喘/季节性过敏性鼻炎导致的直接医疗资源利用情况及相关成本。
共有98名医生为696例患有季节性过敏性鼻炎的哮喘患者提供了数据（意大利：n = 158；波兰：n = 334；西班牙：n = 204）。患者的平均年龄为32.7岁，57.5%为女性，根据全球哮喘防治创议分类，患者的哮喘被认为是轻度持续性（54.5%）或中度持续性（45.5%）。添加孟鲁司特（每日10毫克，每日成本范围为0.8 - 1.68欧元）后，意大利、波兰和西班牙每位患者的年度平均医疗总成本分别增加了11.9%、60.4%和5.5%。然而，在所有三个国家，与哮喘相关的门诊护理、急诊就诊和住院的平均年度成本均显著下降（意大利：从805.00欧元降至281.60欧元[p < 0.01]；波兰：从127.10欧元降至99.00欧元[p < 0.01]；西班牙：从463.40欧元降至119.70欧元[p < 0.01]）。
在轻度至中度哮喘且合并季节性过敏性鼻炎、当前哮喘治疗未充分控制哮喘的患者中添加孟鲁司特进行治疗，可显著减少哮喘 - 过敏联合用药、急诊就诊、门诊护理就诊和住院的使用。添加孟鲁司特后获得的直接医疗总成本仅因孟鲁司特治疗成本而增加。
