Beijing Children's Hospital, Capital Medical University, Beijing, China.
Analysis Group, Inc., Beijing, China.
J Med Econ. 2020 Dec;23(12):1630-1639. doi: 10.1080/13696998.2020.1830410. Epub 2020 Oct 14.
For children aged 1-5 years with persistent asthma, double low-dose inhaled corticosteroids (ICS) are recommended as the preferred Step 3 treatment and low-dose ICS plus leukotriene receptor antagonists (LTRA) as an alternative. Budesonide inhalation suspension (0.5 mg daily) and montelukast (4.0 mg daily) are commonly used low-dose ICS and LTRA, respectively, among children in China. This study compared the cost-effectiveness of double low-dose budesonide vs. low-dose budesonide plus montelukast from a Chinese healthcare payer's perspective.
A Markov model was constructed with four health states (i.e. no exacerbation, mild exacerbation, moderate-to-severe exacerbation, and death). Transition probabilities were estimated based on exacerbation rates, case-fatality of hospitalized patients due to exacerbation, and natural mortality. Treatment adherence was considered and assumed to impact both drug costs and exacerbation rates. Costs (in 2019 Chinese Yuan [¥]) included drug costs and exacerbation management costs. Cost inputs and utilities for each health state were obtained from a public database and the literature. In-depth interviews were conducted with a health economics expert to validate the model, and a clinical expert to verify inputs and assumptions related to clinical practice. Costs and quality-adjusted life-years (QALYs) were estimated over a year. Deterministic and probabilistic sensitivity analyses were performed.
Compared with low-dose budesonide plus montelukast, double low-dose budesonide was associated with lower costs (¥1,534 vs. ¥2,327), fewer exacerbation events (0.43 vs. 1.67) and slightly better QALYs (0.98 vs. 0.97). Sensitivity analyses supported the robustness of the results and the generalizability of findings across geographic regions in China.
The cost-effectiveness analysis suggests that double low-dose budesonide is a dominant Step 3 treatment strategy compared with low-dose budesonide plus montelukast for patients aged 1-5 years with persistent asthma in China.
对于 1-5 岁持续性哮喘儿童，推荐使用双低剂量吸入性皮质类固醇（ICS）作为首选的第 3 步治疗，低剂量 ICS 加白三烯受体拮抗剂（LTRA）作为替代方案。在中国，布地奈德吸入混悬剂（每天 0.5 毫克）和孟鲁司特（每天 4.0 毫克）分别是常用的低剂量 ICS 和 LTRA。本研究从中国医疗保健支付者的角度比较了双低剂量布地奈德与低剂量布地奈德加孟鲁司特的成本效益。
采用 Markov 模型构建了四个健康状态（即无恶化、轻度恶化、中重度恶化和死亡）。根据恶化率、因恶化住院患者的病死率和自然病死率估计转移概率。考虑到治疗依从性，假设其既影响药物成本又影响恶化率。成本（2019 年人民币[¥]）包括药物成本和恶化管理成本。每个健康状态的成本投入和效用均从公共数据库和文献中获得。对一位健康经济学专家进行了深入访谈，以验证模型，对一位临床专家进行了访谈以验证与临床实践相关的投入和假设。在一年内估计成本和质量调整生命年（QALYs）。进行了确定性和概率敏感性分析。
与低剂量布地奈德加孟鲁司特相比，双低剂量布地奈德与较低的成本（¥1534 比 ¥2327）、较少的恶化事件（0.43 比 1.67）和稍好的 QALYs（0.98 比 0.97）相关。敏感性分析支持结果的稳健性以及研究结果在中国不同地理区域的推广。
成本效益分析表明，对于中国 1-5 岁持续性哮喘患者，双低剂量布地奈德是第 3 步治疗的主导策略，优于低剂量布地奈德加孟鲁司特。
