Balkrishnan R, Norwood G J, Anderson A
Division of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy, University of North Carolina at Chapel Hill, USA.
Clin Ther. 1998 May-Jun;20(3):567-80. doi: 10.1016/s0149-2918(98)80066-0.
A retrospective cohort study was conducted to assess the clinical and economic impact of the introduction of inhaled corticosteroid therapy in the North Carolina Medicaid population of patients with asthma. The case group consisted of 180 patients who were followed for 1 year before and 1 year after the initiation of inhaled corticosteroid therapy. The control group consisted of 233 patients whose asthma was of similar severity to that of the case group and who remained on any therapy other than corticosteroids for a continuous 2-year period. After the initiation of inhaled corticosteroid therapy, the case group had reductions of 50% in hospitalizations, 26% in outpatient visits, and 15% in physician visits. At the end of the second year, the control group had significant increases of 23% in hospitalizations and 36% in outpatient visits. All of the changes were statistically significant. However, after adjusting for potential confounding factors, there was a nearly 24% decrease in total health care costs per asthmatic patient per month as a result of the introduction of inhaled corticosteroid therapy. Overall, we found that there was a cost benefit to Medicaid in the introduction of inhaled corticosteroid therapy and that this therapy brought about dramatic decreases in health care utilization and costs.
开展了一项回顾性队列研究，以评估在北卡罗来纳州医疗补助计划覆盖的哮喘患者群体中引入吸入性糖皮质激素疗法的临床和经济影响。病例组由180名患者组成，在开始吸入性糖皮质激素治疗前随访1年，治疗后随访1年。对照组由233名患者组成，他们的哮喘严重程度与病例组相似，且在连续2年的时间里一直接受除糖皮质激素以外的任何治疗。开始吸入性糖皮质激素治疗后，病例组的住院率降低了50%，门诊就诊次数降低了26%，看医生的次数降低了15%。在第二年年底，对照组的住院率显著增加了23%，门诊就诊次数增加了36%。所有这些变化都具有统计学意义。然而，在对潜在的混杂因素进行调整后，由于引入了吸入性糖皮质激素疗法，每名哮喘患者每月的总医疗费用下降了近24%。总体而言，我们发现引入吸入性糖皮质激素疗法对医疗补助计划具有成本效益，并且这种疗法使医疗保健利用率和成本大幅下降。
