Health Outcomes Associates Ltd.; University of Auckland, Auckland, New Zealand.
Biometrics Matters Limited, Hamilton, New Zealand.
Value Health. 2014 Jun;17(4):320-7. doi: 10.1016/j.jval.2014.01.007.
To establish the cost-effectiveness of long-term humidification therapy (LTHT) added to usual care for patients with moderate or severe chronic obstructive pulmonary disease or bronchiectasis.
Resource usage in a 12-month clinical trial of LTHT was estimated from hospital records, patient diaries, and the equipment supplier. Health state utility values were derived from the St. Georges Respiratory Questionnaire (SGRQ) total score. All patients who remained in the trial for 12 months and who had at least 90 days of diary records were included (87 of 108).
Clinical costs were NZ $3973 (95% confidence interval [CI] $1614-$6332) for the control group and NZ $3331 (95% CI $948-$6920) for the intervention group. The mean health benefit per patient was -6.9 SGRQ units (95% CI -13.0 to -7.2; P < 0.05) or +0.0678 quality-adjusted life-years (95% CI 0.001-0.135). With the intervention costing NZ $2059 annually, the mean cost per quality-adjusted life-year was NZ $20,902 (US $18,907) and the bootstrap median was NZ $19,749 (2.5th percentile -$40,923, 97.5th percentile $221,275). At a willingness-to-pay (WTP) threshold of NZ $30,000, the probability of cost-effectiveness was 61%, ranging from 49% to 72% as the cost of LTHT was varied by ±30%. At a WTP of NZ $20,000, the probability was 49% (range 34%-61%).
LTHT is moderately cost-effective for patients with moderate to severe chronic obstructive pulmonary disease or bronchiectasis at a WTP threshold that is acceptable for public funding of medicines in New Zealand. These findings must be interpreted with caution because of the modest size of the clinical study, necessary lack of blinding in the clinical trial, and uncertainty in estimating health state utility from the SQRQ.
评估长期湿化治疗（LTHT）联合常规治疗对中重度慢性阻塞性肺疾病或支气管扩张症患者的成本效果。
从医院记录、患者日记和设备供应商处估算了为期 12 个月的 LTHT 临床试验中的资源使用情况。健康状态效用值来自圣乔治呼吸问卷（SGRQ）总分。所有在试验中持续 12 个月且日记记录至少 90 天的患者（108 例患者中的 87 例）都被纳入。
对照组的临床成本为 3973 新西兰元（95%置信区间[CI]为 1614-6332 新西兰元），干预组为 3331 新西兰元（95%CI 为 948-6920 新西兰元）。每位患者的平均健康效益为-6.9 个 SGRQ 单位（95%CI-13.0 至-7.2；P<0.05）或 0.0678 个质量调整生命年（95%CI 0.001-0.135）。LTHT 每年的干预成本为 2059 新西兰元，每质量调整生命年的平均成本为 20902 新西兰元（2.5 百分位-40923 新西兰元，97.5 百分位 221275 新西兰元）。在支付意愿（WTP）阈值为 30000 新西兰元的情况下，成本效果的概率为 61%，随着 LTHT 成本变化±30%，概率范围为 49%至 72%。在 WTP 为 20000 新西兰元的情况下，概率为 49%（范围为 34%-61%）。
在新西兰药品公共资金可接受的支付意愿阈值下，LTHT 对中重度慢性阻塞性肺疾病或支气管扩张症患者具有中等程度的成本效果。由于临床研究规模较小、临床试验中不可避免的缺乏盲法以及从 SQRQ 估算健康状态效用的不确定性，这些发现必须谨慎解释。
