Rodriguez-Martinez Carlos E, Nino Gustavo, Castro-Rodriguez Jose A
Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
Research Unit, Military Hospital of Colombia, Bogota, Colombia.
Pediatr Pulmonol. 2015 Aug;50(8):735-46. doi: 10.1002/ppul.23073. Epub 2014 Jun 25.
Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies.
A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs).
For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US$437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant.
The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs.
尽管持续吸入糖皮质激素（ICS）已被证明对持续性哮喘有诸多益处，但一种针对轻度哮喘的新策略正在兴起，即采用间歇性或按需使用ICS治疗，并结合短效β2受体激动剂来应对症状。然而，此前尚无研究报告对这两种治疗策略进行经济学评估。
开发了一种马尔可夫类型模型，以估计一组模拟的持续性哮喘儿科患者在12个月期间接受治疗的成本和健康结果。有效性参数来自对文献的系统综述。成本数据来自哥伦比亚卫生部提供的官方数据库。主要结果变量是“质量调整生命年”（QALYs）。
在基础病例分析中，模型显示，与间歇性ICS相比，ICS每日治疗成本更低（学龄儿童和学龄前儿童12个月期间每位患者的平均成本分别为437.02美元对585.03美元以及704.62美元对749.81美元），且QALYs增益最大（学龄儿童和学龄前儿童的QALYs分别为0.9629对0.9392以及0.9238对0.9130），这使得每日治疗被认为具有优势。
本分析表明，与间歇性治疗相比，每日使用ICS治疗复发性喘息和轻度持续性哮喘的儿科患者是一种优势策略（更具成本效益），因为它在总治疗成本较低的情况下显示出更大的QALYs增益。
