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首页> 外文期刊>Pulmonary therapy. >Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2
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Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2

机译：哮喘加强疗法的成本效益作为超细颗粒吸入皮质类固醇或附加长效Beta2剂量的增加

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Introduction Data from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy. Methods This was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12–80?years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β2-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection). Results Patients prescribed ICS dose step-up ( n =?3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA ( n =?3036; mean difference, ￡124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of ￡51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up ( n =?3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers ( n =?6464). Conclusion For asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints. Trial Registration ClinicalTrials.gov identifier: NCT01697722. Funding Teva Pharmaceuticals Limited, Petach Tikva, Israel.
机译：简介需要来自不同医疗保健系统的有关哮喘逐步治疗策略的相对成本效益的数据，以告知决策者和临床医生。我们的目标是从英国国家卫生服务局的角度比较三种通过吸入性糖皮质激素（ICS）单药治疗无法控制的哮喘患者的递增策略的成本效益。方法这是一项对12至80岁年龄段哮喘患者进行匿名医疗记录的历史匹配队列成本-效果分析。我们通过固定剂量联合使用增加剂量（≥50％）的超细颗粒ICS或附加的长效β 2 激动剂（LABA）进行了逐步治疗的双向比较（FDC）ICS / LABA吸入器或通过单独的吸入器。使用一个结局年度中与哮喘相关的直接成本和风险域哮喘控制（无哮喘相关的医院就诊，急性口服糖皮质激素或下呼吸道感染的咨询）的综合量度来计算增量成本效益比（ICER） ）。结果处方ICS剂量增加的患者（n = 3036）与FDC ICS / LABA处方的患者相比，基线调整后的平均哮喘相关医疗费用显着降低（n = 3036;平均差异（124 /年）。 ICS剂量增加的成本降低和有效性降低的可能性为56％（折衷方案），每增加一名FDC控制患者，ICER为51,449英镑; ICS剂量增加是首选治疗策略的可能性为44％（成本更低且更有效）。在第二次比较中，与通过单独的吸入器向ICS中添加LABA相比，ICS升压（n =？3232）更便宜和更有效的可能性为100％（n =？6464）。结论对于哮喘的逐步治疗，从付款人的角度来看，使用超细颗粒ICS增加ICS剂量的费用显着降低，并且与含标准细颗粒ICS的FDC ICS / LABA治疗相比，疗效略微（无明显）降低。这些发现主要适用于英国医疗保健系统，但是在经济拮据的环境中制定指南时需要考虑。试验注册ClinicalTrials.gov标识符：NCT01697722。为以色列Petach Tikva的Teva Pharmaceuticals Limited提供资金。

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