Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Australia.
Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Australia.
J Pediatr. 2014 Sep;165(3):564-569.e5. doi: 10.1016/j.jpeds.2014.05.031. Epub 2014 Jul 1.
To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions.
Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules.
Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902, 95% CI AUD-27 782 to 31 586, P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676, P = .48).
BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings.
确定支气管肺泡灌洗（BAL）指导的治疗是否优于标准治疗，从而降低平均成本，并减少因住院治疗而产生的费用。研究对象为经新生儿筛查诊断为囊性纤维化（CF）的婴儿，他们被随机分配接受 BAL 指导治疗或标准治疗，直到他们年满 5 岁。本研究采用医疗保健资金提供者的视角，根据所有研究点的标准化数据收集表来评估资源使用情况，主要从政府预算中获取单位成本。
这是一项在澳大利亚和新西兰开展的随机对照试验，研究对象为经新生儿筛查诊断为 CF 的婴儿，他们被随机分配接受 BAL 指导治疗或标准治疗，直到他们年满 5 岁。本研究采用医疗保健资金提供者的视角，根据所有研究点的标准化数据收集表来评估资源使用情况，主要从政府预算中获取单位成本。
在研究期间，BAL 指导治疗组的每个孩子的平均费用为 92860 澳元（AUD），标准治疗组为 90958AUD（平均差异 AUD1902，95%置信区间 AUD-27782 至 31586，P =.90）。在研究期间，BAL 指导治疗组每个孩子的平均住院费用为 57302AUD，标准治疗组为 66590AUD（平均差异 AUD-9288，95%置信区间 AUD-35252 至 16676，P =.48）。
与仅根据临床特征和咽拭子培养结果采用标准方案治疗 CF 患者相比，BAL 指导治疗并未降低平均住院费用或总体费用。基于我们之前的研究结果，BAL 指导治疗在 5 岁时并未提供优于标准治疗的临床优势，因此不能基于总体成本节约而推荐 BAL 用于学龄前 CF 儿童的常规治疗。
