Gama Elvis, Madan Jason, Banda Hastings, Squire Bertie, Thomson Rachael, Namakhoma Ireen
Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
Implement Sci. 2015 Jan 8;10:1. doi: 10.1186/s13012-014-0195-8.
Chronic airway diseases pose a big challenge to health systems in most developing countries, particularly in Sub-Saharan Africa. A diagnosis for people with chronic or persistent cough is usually delayed because of individual and health system barriers. However, delayed diagnosis and treatment facilitates further transmission, severity of disease with complications and mortality. The objective of this study is to assess the cost-effectiveness of the practical approach to lung health strategy, a patient-centred approach for diagnosis and treatment of common respiratory illnesses in primary healthcare settings, as a means of strengthening health systems to improve the quality of management of respiratory diseases.
METHODS/DESIGN: Economic evaluation nested in a cluster randomised controlled trial with three arms will be performed. Measures of effectiveness and costs for all arms of the study will be obtained from the cluster randomised controlled clinical trial. The main outcome measures are a combined rate of major respiratory diseases milestones and process indicators extracted from the practical approach to lung health strategy. For analysis, descriptive as well as regression techniques will be used. A cost-effectiveness analysis will be performed according to intention-to-treat principle and from a societal perspective. Cost-effectiveness ratios will be calculated using bootstrapping techniques.
We hope to demonstrate the cost-effectiveness of the practical approach to lung health and informal healthcare providers, see an improvement in patients' quality of life, achieve a reduction in the duration and occurrence of episodes and the chronicity of respiratory diseases, and are able to report a decrease in the social cost. If the practical approach to lung health and informal healthcare provider's interventions are cost-effective, they could be scaled up to all primary healthcare centres.
PACTR: PACTR201411000910192.
慢性气道疾病对大多数发展中国家的卫生系统构成了巨大挑战，尤其是在撒哈拉以南非洲地区。由于个人和卫生系统的障碍，慢性或持续性咳嗽患者的诊断通常会延迟。然而，诊断和治疗的延迟会促进疾病的进一步传播、病情严重程度及并发症和死亡率的增加。本研究的目的是评估肺部健康战略实用方法的成本效益，这是一种以患者为中心的方法，用于在初级卫生保健环境中诊断和治疗常见呼吸道疾病，以此作为加强卫生系统以提高呼吸道疾病管理质量的一种手段。
方法/设计：将在一项有三个组的整群随机对照试验中进行经济评估。研究所有组的有效性和成本测量将从整群随机对照临床试验中获得。主要结局指标是主要呼吸道疾病里程碑的综合发生率以及从肺部健康战略实用方法中提取的过程指标。分析将使用描述性和回归技术。将根据意向性分析原则并从社会角度进行成本效益分析。成本效益比率将使用自抽样技术计算。
我们希望证明肺部健康实用方法和非正规医疗服务提供者的成本效益，看到患者生活质量的改善，实现发作持续时间和发生率以及呼吸道疾病慢性化的降低，并能够报告社会成本的下降。如果肺部健康实用方法和非正规医疗服务提供者的干预措施具有成本效益，它们可以扩大到所有初级卫生保健中心。
泛非临床试验注册平台（PACTR）：PACTR201411000910192。
