Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, 11562, Cairo, Egypt.
Department of Pulmonology, Faculty of Medicine, Cairo University, 11562, Cairo, Egypt.
BMC Pulm Med. 2024 Feb 15;24(1):87. doi: 10.1186/s12890-024-02896-z.
Interstitial lung diseases (ILDs) are caused by inflammation and/or fibrosis of alveolar walls resulting in impaired gas exchange. Hypersensitivity pneumonitis (HP) is the third most common type of ILDs. Corticosteroids are the mainstay treatment for HP. The use of intramuscular (IM) betamethasone or intravenous (IV) dexamethasone as weekly pulse doses has shown higher benefit than daily oral prednisolone for HP patients. The aim of this study is to directly compare different corticosteroids in terms of effectiveness and in monetary values and perform an economic evaluation.
One hundred and seven patients were tested for pulmonary function tests (PFTs) and inflammatory markers to assess the treatment effectiveness. A cost-effectiveness analysis (CEA) was performed. ICERs between 3 treatment groups were calculated.
Post treatment, Krebs von den Lungen-6 (KL-6) levels significantly improved in betamethasone group from 723.22 ± 218.18 U/ml to 554.48 ± 129.69 U/ml (p = 0.001). A significant improvement in erythrocyte sedimentation rate (ESR) occurred in the dexamethasone group from 56.12 ± 27.97 mm to 30.06 ± 16.04 mm (p = 0.048). A significant improvement in forced expiratory volume (FEV), forced vital capacity (FVC) and six-minute walk distance (6MWD) was observed within the three treatment groups. A significant improvement in oxygen desaturation percentage (SpO) occurred within dexamethasone and betamethasone groups. Betamethasone and dexamethasone were found more cost-effective than prednisolone as their ICERs fell in quadrant C. Furthermore, ICER between betamethasone and dexamethasone was performed; a small difference in cost was found compared to the higher benefit of betamethasone.
Betamethasone and dexamethasone were found to be more effective than prednisolone in improving the inflammatory reaction and the clinical features of HP patients. Betamethasone was found to be the best intervention in terms of cost against the effect.
间质性肺病（ILDs）是由肺泡壁的炎症和/或纤维化引起的，导致气体交换受损。过敏性肺炎（HP）是第三大常见类型的ILDs。皮质类固醇是 HP 的主要治疗方法。与每日口服泼尼松龙相比，肌肉内（IM）倍他米松或静脉内（IV）地塞米松作为每周脉冲剂量已显示出对 HP 患者更高的益处。本研究旨在直接比较不同皮质类固醇在有效性和货币价值方面的差异，并进行经济评估。
对 107 名患者进行肺功能测试（PFTs）和炎症标志物检测，以评估治疗效果。进行成本效益分析（CEA）。计算 3 个治疗组之间的增量成本效益比（ICER）。
治疗后，倍他米松组的 Krebs von den Lungen-6（KL-6）水平从 723.22±218.18 U/ml 显著改善至 554.48±129.69 U/ml（p=0.001）。地塞米松组的红细胞沉降率（ESR）从 56.12±27.97 mm 显著改善至 30.06±16.04 mm（p=0.048）。三组患者的用力呼气量（FEV）、用力肺活量（FVC）和 6 分钟步行距离（6MWD）均有显著改善。地塞米松和倍他米松组的血氧饱和度（SpO）下降百分比有显著改善。倍他米松和地塞米松的增量成本效益比（ICER）落入象限 C，因此被认为比泼尼松龙更具成本效益。此外，还对倍他米松和地塞米松的 ICER 进行了比较，发现与倍他米松的较高效益相比，成本差异较小。
倍他米松和地塞米松在改善 HP 患者的炎症反应和临床特征方面比泼尼松龙更有效。从成本效益的角度来看，倍他米松被认为是最佳干预措施。
