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治疗儿童哮喘的各种选择的成本考虑。

Cost considerations of therapeutic options for children with asthma.

机构信息

Respiratory Department, Sydney Childrens Hospital, Randwick, Sydney, NSW, Australia.

出版信息

Paediatr Drugs. 2012 Aug 1;14(4):211-20. doi: 10.2165/11597360-000000000-00000.

Abstract

Asthma is a prevalent health condition in children, with economic implications for the individual and their family, as well as for societies with nationalized healthcare. Pharmaceutical cost is the main driver of healthcare expenditure in asthma. Existent explicit guidelines are meant to guide asthma management across all age groups, but they are failing. Pharmacologic management of asthma consists of a stepwise treatment approach to achieve symptom control. Various studies suggest a significant number of medical practitioners are prescribing inhaled corticosteroids (ICS) and ICS/long-acting beta agonist (LABA) combination inhalers inappropriately, including prescribing high doses of ICS without specialist consultation. ICS/LABA combination inhalers should only be used in persistent asthmatics, which account for approximately 5% of all children with asthma. Despite this, there is an increase in prescribing rates of ICS/LABA combination inhalers in the context of a decrease in the prevalence of asthma. Furthermore, there is inappropriate prescribing of ICS/LABA combination inhalers in children under 5 years of age, and initiation of relatively more expensive ICS/LABA combination inhalers in patients who have not previously been prescribed ICS. There is evidence to suggest that cost is a significant barrier to asthma management, especially for the more expensive ICS/LABA combination inhalers. Hence, prescribing cost-effective asthma medications appropriately is one of the most important strategies in reducing the morbidity and mortality associated with asthma. It is incumbent on every medical practitioner to not prescribe expensive medications if not indicated, both for the sake of the patient and for society.

摘要

哮喘是儿童中常见的健康问题,对个人及其家庭以及实行国家医疗保健的社会都有经济影响。药物成本是哮喘医疗支出的主要驱动因素。现有的明确指南旨在指导所有年龄段的哮喘管理,但它们正在失效。哮喘的药物治疗包括逐步治疗方法,以实现症状控制。多项研究表明,相当多的医疗从业者不恰当地开具吸入皮质类固醇(ICS)和 ICS/长效β激动剂(LABA)联合吸入器,包括在没有专家咨询的情况下开具高剂量 ICS。ICS/LABA 联合吸入器仅应用于持续性哮喘患者,约占所有哮喘儿童的 5%。尽管如此,在哮喘患病率下降的情况下,ICS/LABA 联合吸入器的开具率仍在增加。此外,5 岁以下儿童不恰当地开具 ICS/LABA 联合吸入器,以及在未开具 ICS 的患者中开始使用相对昂贵的 ICS/LABA 联合吸入器。有证据表明,成本是哮喘管理的一个重要障碍,尤其是对于更昂贵的 ICS/LABA 联合吸入器。因此,适当开具具有成本效益的哮喘药物是降低与哮喘相关的发病率和死亡率的最重要策略之一。每个医疗从业者都有责任在没有指征的情况下不开具昂贵的药物,这不仅是为了患者,也是为了社会。

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