Lloyd Andrew, Doyle Scott, Dewilde Sarah, Turk Florian
Oxford Outcomes Ltd, West Way, Oxford, OX2 0JJ, UK.
Eur J Health Econ. 2008 Aug;9(3):275-84. doi: 10.1007/s10198-007-0075-0. Epub 2007 Nov 24.
Patients with moderate to severe allergic asthma have persistent poorly controlled asthma despite inhaled or systemic corticosteroid therapy. New therapies are becoming more widely available to treat such patients, but their value needs to be formally assessed in an economic evaluation. Within a publicly funded health care system such an analysis should reflect societal preferences when measuring treatment benefits. The aim of this study was to elicit societal preferences for the symptom burden associated with moderate to severe allergic asthma.
Existing daily symptom diary data from a clinical trial were used to develop health state descriptions for evaluation in a standard gamble interview. Five health states were produced that reflected five distinct levels of control ranging from 'complete control of asthma' to 'worsening of asthma', as defined by another outcome measure. The symptom diary data were also used as attributes in a discrete choice experiment (DCE) to estimate willingness to pay for improvements in symptoms. Members of the general public (n = 101) completed the interview.
Thirteen participants failed the consistency checks and were excluded from the analysis. Societal utility ratings for the health states ranged from 0.71 (worsening of asthma) to 0.78 (complete control of asthma). The participants were also willing to pay 160 pounds a month for the avoidance of all symptoms.
The range of utility values (0.71-0.78) demonstrates the severity of moderate to severe allergic asthma. However the spread of scores between complete control of asthma and worsening of asthma was lower than was expected. The community sample placed only a moderate value on the avoidance of all asthma symptoms in the DCE survey. The results suggest that the community sample may not have fully understood the benefits of control over asthma symptoms and the limitations such symptoms can impose on everyday life.
中度至重度过敏性哮喘患者尽管接受了吸入或全身糖皮质激素治疗，但哮喘仍持续控制不佳。新的治疗方法越来越广泛地用于治疗此类患者，但其价值需要在经济评估中进行正式评估。在公共资助的医疗保健系统中，这种分析在衡量治疗效益时应反映社会偏好。本研究的目的是了解社会对中度至重度过敏性哮喘相关症状负担的偏好。
利用一项临床试验中现有的每日症状日记数据，制定健康状态描述，以便在标准博弈访谈中进行评估。根据另一项结果指标的定义，生成了五种健康状态，反映了从“哮喘完全控制”到“哮喘恶化”的五个不同控制水平。症状日记数据也被用作离散选择实验（DCE）中的属性，以估计为改善症状而支付的意愿。普通公众成员（n = 101）完成了访谈。
13名参与者未通过一致性检查，被排除在分析之外。健康状态的社会效用评分范围为0.71（哮喘恶化）至0.78（哮喘完全控制）。参与者还愿意每月支付160英镑以避免所有症状。
效用值范围（0.71 - 0.78）表明了中度至重度过敏性哮喘的严重程度。然而，哮喘完全控制和哮喘恶化之间的评分差异低于预期。在DCE调查中，社区样本对避免所有哮喘症状的重视程度仅为中等。结果表明，社区样本可能没有完全理解控制哮喘症状的益处以及这些症状对日常生活可能造成的限制。
