Sakai Michi, Shimbo Takuro, Omata Kazumi, Takahashi Yoshimitsu, Satomura Kazunari, Kitamura Tetsuhisa, Kawamura Takashi, Baba Hisamitsu, Yoshihara Masaharu, Itoh Hiroshi
Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo, Japan.
BMC Health Serv Res. 2008 Dec 16;8:258. doi: 10.1186/1472-6963-8-258.
In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective.
Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.
After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence.
This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.
在日本，漱口是预防上呼吸道感染（URTI）普遍认可的方法。一项随机对照试验比较了漱口组和对照组的URTI发病率，结果显示了漱口预防URTI的有效性。从第三方支付方的角度来看，漱口占主导地位，因为漱口的费用由参与者承担。然而，应从社会角度考虑漱口的成本效益。在本研究中，开展了一项与随机对照试验同步进行的经济学评估，以从社会角度评估漱口预防URTI的成本效益。
在漱口试验的参与者中，122名漱口者和130名对照者参与了经济分析。在意向性分析的基础上，比较了两组60天的累积随访成本以及通过质量调整生命天（QALD）衡量的有效性。增量成本效益比（ICER）换算为每质量调整生命年（QALY）的美元数。通过自抽样法估计95%置信区间（95%CI）以及漱口具有成本效益的概率。
60天后，漱口组的QALD增加了0.43，成本比对照组高37.1美元。漱口组的ICER为31,800美元/QALY（95%CI，1,900美元 - 248,100美元）。尽管这类似于许多可接受的医疗干预形式，包括诸如流感疫苗接种等URTI预防措施，但较宽的置信区间表明我们的结果存在不确定性。此外，单向敏感性分析还表明，需要仔细评估漱口成本和中度URTI的效用。本研究的主要局限性在于该试验是在冬季进行的，此时URTI很普遍。将结果应用于URTI不普遍的季节时必须谨慎，因为发病率降低会导致ICER增加。
本研究表明，漱口是一种从第三方支付方和社会角度都可接受的、具有成本效益的URTI预防策略。
