Rodriguez-Martinez Carlos E, Sossa-Briceño Monica P, Soto-Martinez Manuel E
Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia.
Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
J Allergy Clin Immunol Pract. 2023 Jan;11(1):220-227. doi: 10.1016/j.jaip.2022.09.039. Epub 2022 Oct 13.
Although increasing recent evidence has shown the efficacy of bacterial lysate therapy for the prevention of wheezing episodes and asthma exacerbations in pediatric patients, evidence of its cost-effectiveness in preschool patients is scarce.
To evaluate the cost-utility of bacterial lysate therapy as an add-on to standard care of preschool children with recurrent wheezing.
To achieve the objectives of the study, we used a Markov simulation model with 3 mutually exclusive nonabsorbent states (regular Markov chain). Effectiveness parameters were obtained from a recent systematic review of the literature with meta-analyses (5 randomized controlled trials, 433 children). Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national health care system in Colombia. The main outcome of the model was quality-adjusted life-years. To assess the robustness of the model's results, we performed deterministic and probabilistic sensitivity analysis.
Compared with standard care, bacterial lysate add-on therapy to standard care was associated with lower overall treatment costs (US $694.03 vs $830.71 average cost per patient) and the greatest gain in QALYs (0.9211 vs 0.9154 QALYs on average per patient), thus showing dominance.
In Colombia, compared with standard care, bacterial lysate add-on therapy to standard care for treating preschool children with recurrent wheezing is a dominant strategy because it showed a greater gain in QALYs at lower total treatment costs.
尽管最近越来越多的证据表明细菌溶解产物疗法在预防儿科患者喘息发作和哮喘加重方面具有疗效，但关于其在学龄前患者中的成本效益证据却很少。
评估细菌溶解产物疗法作为复发性喘息学龄前儿童标准治疗附加疗法的成本效益。
为实现本研究目标，我们使用了具有3个相互排斥的非吸收状态（常规马尔可夫链）的马尔可夫模拟模型。有效性参数来自最近一项进行了荟萃分析的文献系统评价（5项随机对照试验，433名儿童）。成本数据来自医院账单和哥伦比亚国家药品价格手册。本研究是从哥伦比亚国家医疗保健系统的角度进行的。该模型的主要结果是质量调整生命年。为评估模型结果的稳健性，我们进行了确定性和概率性敏感性分析。
与标准治疗相比，在标准治疗基础上加用细菌溶解产物疗法可降低总体治疗成本（平均每位患者694.03美元 vs 830.71美元），并在质量调整生命年方面获得最大收益（平均每位患者0.9211个质量调整生命年 vs 0.9154个质量调整生命年），因此显示出优势。
在哥伦比亚，与标准治疗相比，在标准治疗基础上加用细菌溶解产物疗法治疗复发性喘息学龄前儿童是一种优势策略，因为它在较低的总治疗成本下在质量调整生命年方面有更大的收益。
