Ramos G Feljandro P, van Asselt Antoinette D I, Kuiper Sandra, Severens Johan L, Maas Tanja, Dompeling Edward, Knottnerus J André, van Schayck Onno C P
Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
Eur J Health Econ. 2014 Nov;15(8):869-83. doi: 10.1007/s10198-013-0532-x. Epub 2013 Oct 6.
Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework.
A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses.
The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of
This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.
许多儿童有望通过初级预防（即从产前开始）终身摆脱哮喘，初级预防采用单因素（UF）方法应对一种环境暴露，或采用多因素（MF）方法应对至少两种环境暴露。我们在一个决策分析框架中评估了荷兰儿童初级预防项目的成本效益。
开发了一个决策分析树模型，分析医疗保健成本和预防的哮喘病例，以比较常规护理（UC）与两个UF项目和三个MF项目在儿童哮喘初级预防方面的效果。通过增量成本效益比和净货币效益对项目进行评估。对决策和参数不确定性进行信息价值分析。
当前的UC和三个MF项目中的一个优于其他方案。MF项目成本更高，但效果也比UC更好，增量成本效益比为每预防一例额外哮喘病例<8209.20欧元。降低不确定性的完美信息价值最低为2.916亿欧元。成本效益阈值的大部分不确定性归因于低风险儿童的概率和成本估计。
本研究支持一项结构化项目的可行性，该项目同时应对屋尘螨暴露、宠物皮屑、环境烟草暴露和母乳喂养，作为儿童哮喘初级预防中UC的一种具有成本效益的替代方案。
