Chuck Anderson, Jacobs Philip, Mayers Irvin, Marciniuk Darcy
Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
Can Respir J. 2008 Nov-Dec;15(8):437-43. doi: 10.1155/2008/257618.
There is evidence that combination therapy (CT) in the form of long-acting beta(2)-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).
To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.
A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV(1)] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV(1) less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality- adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.
CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.
Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV(1) worsens and reaches 50% of predicted values, CT is recommended.
有证据表明，长效β2受体激动剂（LABA）与吸入性糖皮质激素联合治疗（CT）可改善慢性阻塞性肺疾病（COPD）患者的肺功能。
确定在无、所有或选定的一组COPD患者中使用CT的成本效益。
设计了一个马尔可夫模型来比较四种治疗策略：无论COPD严重程度如何均不使用CT（患者仅接受LABA）；仅在3期疾病患者中使用CT（第1秒用力呼气量[FEV(1)]低于预测值的35%）；仅在2期和3期疾病患者中使用CT（FEV(1)低于预测值的50%）；以及在所有COPD患者中使用CT，无论其严重程度如何。死亡率、急性加重率和疾病进展率、质量调整生命年（QALY）和成本的估计值均来自文献。采用了三年和终身的时间范围。分析是从卫生系统的角度进行的。
如果给予3期疾病患者CT，每获得一个QALY的成本为39,000美元；如果给予2期和3期疾病患者，每获得一个QALY的成本为47,500美元；如果给予所有COPD患者，每获得一个QALY的成本为450,333美元。在蒙特卡罗模拟中对各种假设进行测试后，结果是稳健的。
为2期或3期疾病的COPD患者提供CT具有成本效益。给家庭医生和专科医生的信息是，随着FEV(1)恶化并达到预测值的50%，建议使用CT。
