Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
BMJ Open Respir Res. 2021 Nov;8(1). doi: 10.1136/bmjresp-2021-000881.
There is no definitive cure for asthma, as prevention remains a major goal. Decision analytic models are routinely used to evaluate the value-for-money proposition of interventions. Following best practice standards in decision-analytic modelling, the objective of this study was to solicit expert opinion to develop a concept map for a policy model for primary prevention of asthma.
We reviewed currently available decision analytic models for asthma prevention. A steering committee of economic modellers, allergists and respirologists was then convened to draft a conceptual model of paediatric asthma. A modified Delphi method was followed to define the context of the problem at hand (evaluation of asthma prevention strategies) and develop the concept map of the model.
Consensus was achieved after three rounds of discussions, followed by concealed voting. In the final conceptual model, asthma diagnosis was based on three domains of lung function, atopy and their symptoms. The panel recommended several markers for each domain. These domains were in turn affected by several risk factors. The panel clustered all risk factors under three groups of 'patient characteristic', 'family history' and 'environmental factors'. To be capable of modelling the interplay among risk factors, the panel recommended the use of microsimulation, with an open-population approach that would enable modelling phased implementation and gradual and incomplete uptake of the intervention.
Economic evaluation of childhood interventions for preventing asthma will require modelling of several codependent risk factors and multiple domains that affect the diagnosis. The conceptual model can inform the development and validation of a policy model for childhood asthma prevention.
目前尚无哮喘的根治方法，因此预防仍是主要目标。决策分析模型常用于评估干预措施的性价比。本研究旨在遵循决策分析模型的最佳实践标准，征求专家意见，制定用于儿童哮喘初级预防的政策模型的概念图。
我们回顾了目前可用于哮喘预防的决策分析模型。然后召集了经济建模者、过敏症专家和呼吸科专家组成指导委员会，起草了儿科哮喘政策模型的概念模型。采用改良 Delphi 法来确定手头问题的背景（评估哮喘预防策略）并制定模型的概念图。
经过三轮讨论和不公开投票达成了共识。在最终的概念模型中，哮喘诊断基于肺功能、特应性及其症状三个领域。专家组为每个领域推荐了几个标志物。这些领域反过来又受到多个危险因素的影响。专家组将所有危险因素分为“患者特征”、“家族史”和“环境因素”三组。为了能够对危险因素之间的相互作用进行建模，专家组建议使用微观模拟，采用开放式人群方法，能够对干预措施的分阶段实施和逐渐不完全采用进行建模。
对预防儿童哮喘的干预措施进行经济评估将需要对影响诊断的几个相互依存的危险因素和多个领域进行建模。该概念模型可为儿童哮喘预防政策模型的开发和验证提供信息。
