Research group in Pharmacology and Toxicology" INFARTO". Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia.
Department of Pediatrics, Hospital Infantil Concejo de Medellín, Medellín, Colombia.
J Asthma. 2022 Oct;59(10):2008-2015. doi: 10.1080/02770903.2021.1980586. Epub 2021 Sep 22.
An important proportion of asthma patients remain uncontrolled despite the use of inhaled corticosteroids and long-acting beta-agonists. Some add-on therapies, like azithromycin, have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of azithromycin as an add-on therapy to ICS + LABA for patients with severe asthma.
A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. The total costs and QALYS of two interventions, including standard therapy (ICS + LABA), and add-on therapy with azithromycin, were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000.
The model suggests a potential gain of 0.037 QALYs per patient per year on azithromycin, with a difference of US $718 in favor of azithromycin, showing dominance with respect to SOC. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. In the deterministic sensitivity analyses, our base-case results were robust to variations in all assumptions and parameters.
Add-on therapy with azithromycin was found to be cost-effective when added to usual care in patients who remain uncontrolled despite treatment with medium or high-dose ICS/LABA.
尽管使用吸入皮质类固醇和长效β激动剂，仍有相当一部分哮喘患者未能得到控制。对于这一小部分患者，一些附加治疗方法，如阿奇霉素，已被推荐使用。本研究旨在评估阿奇霉素作为中高剂量吸入皮质类固醇/长效β激动剂联合治疗方案的附加疗法，对于严重哮喘患者的成本效益。
为了评估阿奇霉素作为中高剂量吸入皮质类固醇/长效β激动剂联合治疗方案的附加疗法，对于严重哮喘患者的成本效益，我们建立了一个概率性 Markov 模型来估计哥伦比亚严重哮喘患者的成本和质量调整生命年（QALYs）。计算了两种干预措施（标准治疗[ICS/LABA]和阿奇霉素附加治疗）的总成本和 QALYs，包括终生。进行了多次敏感性分析。以支付意愿值 19,000 美元为标准，评估成本效益。
该模型表明，在阿奇霉素治疗组中，每位患者每年潜在增加 0.037 个 QALYs，而阿奇霉素治疗组比 SOC 组每年多花费 718 美元，表现出相对于 SOC 的优势。优势地位排除了计算增量成本效益比的需要。在确定性敏感性分析中，我们的基本案例结果在所有假设和参数的变化下都是稳健的。
在中高剂量 ICS/LABA 治疗后仍未得到控制的患者中，附加阿奇霉素治疗被发现是具有成本效益的。
