慢性鼻窦炎患者接受药物治疗的健康效用结果：一项前瞻性多机构研究。
Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study.
作者信息
Luk Lauren J, Steele Toby O, Mace Jess C, Soler Zachary M, Rudmik Luke, Smith Timothy L
机构信息
Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
出版信息
Int Forum Allergy Rhinol. 2015 Nov;5(11):1018-27. doi: 10.1002/alr.21588. Epub 2015 Jul 3.
BACKGROUND
A health utility value represents an individual's preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS).
METHODS
The Medical Outcomes Study Short Form-6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA).
RESULTS
Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ(2) = 6.91; p = 0.009) and surgical intervention (χ(2) = 8.11; p = 0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (mean ± standard deviation; 0.76 ± 0.12 vs 0.70 ± 0.15; p = 0.023). Significant improvement in health utility was reported in the ESS cohort (F(2) = 37.69; p < 0.001), whereas values remained stable, without significant improvement, in both the medical therapy cohort (F(2) = 0.03; p = 0.967) and treatment crossover cohort (F(2) = 2.36; p = 0.115).
CONCLUSION
Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS show significant improvement in health utility, whereas those electing continued medical management demonstrate stable health utility over 12 months.
背景
健康效用值代表个体对处于特定健康状态的偏好，用于成本效用分析。本研究调查持续药物治疗对慢性鼻-鼻窦炎（CRS）患者健康效用结果的影响。
方法
对前瞻性纳入一项纵向研究以检查CRS治疗结果的患者进行医学结局研究简表6D（SF-6D）问卷调查。患者接受了积极的初始药物治疗，然后选择继续药物治疗（n = 40）或接受鼻内镜鼻窦手术（ESS），随后进行药物治疗（n = 152）。对通过治疗交叉至ESS的患者也进行了评估（n = 20）。在基线、6个月和12个月随访时为两个队列生成健康效用值（SF-6D），并使用重复测量方差分析（ANOVA）进行评估。
结果
发现治疗交叉患者既往鼻窦手术的患病率显著高于药物治疗组（χ(2)=6.91；p = 0.009）和手术干预组（χ(2)=8.11；p = 0.004）。与ESS队列相比，药物治疗队列的平均基线效用值显著更好（均值±标准差；0.76±0.12对0.70±0.15；p = 0.023）。ESS队列报告健康效用有显著改善（F(2)=37.69；p < 0.001），而药物治疗队列（F(2)=0.03；p = 0.967）和治疗交叉队列（F(2)=2.36；p = 0.115）的值保持稳定，无显著改善。
结论
与选择ESS的患者相比，选择继续药物治疗的患者报告的基线健康效用更好。选择ESS的患者健康效用有显著改善，而选择继续药物治疗的患者在12个月内健康效用保持稳定。
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