Gerdtham U G, Hertzman P, Jönsson B, Boman G
Centre for Health Economics, Stockholm School of Economics, Sweden.
Med Care. 1996 Dec;34(12):1188-98. doi: 10.1097/00005650-199612000-00004.
In clinical studies, it has been found that treating asthmatic patients with inhaled corticosteroids can reduce the need for in-patient care. The purpose of this study was to determine if such a relationship could be observed in available health-care statistics in Sweden and, if such a relationship could be established, what health economic consequences it implied.
A retrospective study was conducted using regional data on acute hospitalization-ie, number of bed-days in acute somatic in-patient care clinics-and sales of anti-asthmatic drugs from 14 health-care administrative regions, covering 6 million people (71% of the Swedish population) between 1978 and 1991. The data were analyzed in multiple regression analyses where time- and cross-section data were pooled. The variation in bed-days was explained by three variables: (1) the sales of inhaled corticosteroids, (2) the total number of bed-days within acute somatic in-patient care, and (3) the sales of inhaled bronchodilators, which were used as a proxy variable for asthma prevalence.
The total number of bed-days due to asthma in the 14 county councils did not show any upward or downward trend between 1978 and 1985. However, after 1985, there was a significant downward trend despite an increase in estimated asthma prevalence. Increased sales of inhaled corticosteroids were significantly correlated (P < 0.01) with a reduction in bed-days due to asthma. The model used indicated that an increase in sales of inhaled corticosteroids by 1 defined daily dose (DDD) per day and 1,000 inhabitants gave, on average over the study period, a reduction of 1.5 bed-days for asthma in acute in-patient care per 1,000 inhabitants.
Clinical trial findings that treating asthmatic patients with inhaled corticosteroids improves asthma control and reduces the need for hospitalization, seem to be realized in clinical practice. The increased costs of inhaled corticosteroids to the health-care system were more than offset by a reduction in the costs for acute somatic hospital care.
在临床研究中，已发现用吸入性糖皮质激素治疗哮喘患者可减少住院护理需求。本研究的目的是确定在瑞典现有的医疗保健统计数据中是否能观察到这种关系，以及如果能建立这种关系，它会带来哪些健康经济后果。
采用回顾性研究，使用来自14个医疗保健行政区的急性住院区域数据，即急性躯体住院护理诊所的住院天数，以及1978年至1991年间抗哮喘药物的销售情况。这些数据涵盖600万人（占瑞典人口的71%）。数据在多元回归分析中进行分析，其中时间和横截面数据合并在一起。住院天数的变化由三个变量解释：（1）吸入性糖皮质激素的销售额，（2）急性躯体住院护理中的总住院天数，（3）吸入性支气管扩张剂的销售额，其用作哮喘患病率的替代变量。
1978年至1985年间，14个郡议会因哮喘导致的总住院天数没有呈现任何上升或下降趋势。然而，1985年之后，尽管估计的哮喘患病率有所上升，但仍有显著的下降趋势。吸入性糖皮质激素销售额的增加与因哮喘导致的住院天数减少显著相关（P < 0.01）。所使用的模型表明，在研究期间，每天每1000名居民吸入性糖皮质激素销售额增加1个限定日剂量（DDD），平均每1000名居民在急性住院护理中因哮喘导致的住院天数减少1. .5天。
临床试验结果表明，用吸入性糖皮质激素治疗哮喘患者可改善哮喘控制并减少住院需求，这似乎在临床实践中得到了体现。吸入性糖皮质激素给医疗保健系统增加的成本被急性躯体医院护理成本的降低所抵消。
