Graf von der Schulenburg J M, Greiner W, Molitor S, Kielhorn A
Institut für Versicherungbetriebslehre, Universität Hannover.
Med Klin (Munich). 1996 Oct 15;91(10):670-6.
The aim of asthma therapy, i.e. the permanent elimination of the patient's symptoms, is as a rule, achievable over the long-term only with the aid of anti-inflammatory drugs. As well as medical, this approach also has considerable economic implications. The comparatively low compliance among asthmatics makes treatment in this context all the more difficult. An alternative that presents itself is the use of combination preparations, a mixture of a long-term prophylactic and a therapeutic agent.
With the aid of standardised questionnaires, data were acquired from 216 patients and assigned to subgroups in accordance with the degree of severity of the asthma. The patients were treated in the offices of a total of 23 GPs and internists selected at random from a complete list of all relevant practices in Germany. The use of resources, i.e. all diagnostic and therapeutic measures, was recorded retrospectively for a period of 1 year. In this way, all those resources of relevance to the health insurance carriers used during the observation period were identified. In addition to direct costs, so-called indirect costs were also estimated, i.e. in the present study the productivity loss to the economy due to illness-related absence from work.
The annual cost of treating adult asthmatics was calculated to be DM 3,339 for level 1 severity, DM 5,260 for level 2 severity and DM 12,016 for level 3 severity. As the illness progresses in particular the direct cost of inpatient care and the indirect costs rise disproportionately. The yearly expenditure for women sufferers is about DM 800 more than for male sufferers. The direct cost of asthma treatment in children amounts to DM 2,950 for level 1, DM 3,225 for level 2, and DM 4,811 for level 3, severity. Here, drug-related costs in particular, rise significantly as the disease progresses.
One of the results of the present study is the fact that for asthma sufferers in general, there is a positive correlation between average total costs and degree of severity. It may thus be postulated that preventive medical treatment of asthma that slows the progression of the illness, together with appropriate patient instruction, would have a positive effect on the total expenditure per patient. If, for example, the appropriate use of drugs in combination with patient instruction improved the compliance of asthmatics, lower treatment costs and a better quality of life for the patient could be expected.
哮喘治疗的目标，即永久消除患者症状，通常只有借助抗炎药物才能长期实现。这种方法除了具有医学意义外，还具有相当大的经济影响。哮喘患者相对较低的依从性使得在这种情况下的治疗更加困难。一种可行的替代方法是使用复方制剂，即一种长效预防药物和一种治疗药物的混合物。
借助标准化问卷，从216名患者那里获取数据，并根据哮喘严重程度将其分为不同亚组。这些患者在德国所有相关诊所的完整名单中随机挑选的23名全科医生和内科医生的诊所接受治疗。对为期1年的资源使用情况，即所有诊断和治疗措施进行回顾性记录。通过这种方式，确定了观察期内与健康保险公司相关的所有资源。除了直接成本外，还估算了所谓的间接成本，即在本研究中，因患病缺勤给经济带来的生产力损失。
计算得出，1级严重程度的成年哮喘患者年治疗成本为3339德国马克，2级严重程度为5260德国马克，3级严重程度为12016德国马克。随着病情进展，尤其是住院护理的直接成本和间接成本会不成比例地增加。女性患者的年度支出比男性患者约多800德国马克。1级严重程度的儿童哮喘治疗直接成本为2950德国马克，2级为3225德国马克，3级为4811德国马克。在这里，尤其是与药物相关的成本会随着疾病进展而显著增加。
本研究的结果之一是，一般而言，哮喘患者的平均总成本与严重程度之间存在正相关。因此可以推测，减缓疾病进展的哮喘预防性医疗措施以及适当的患者指导，将对每位患者的总支出产生积极影响。例如，如果合理使用药物并结合患者指导提高了哮喘患者的依从性，有望降低治疗成本并提高患者生活质量。
