慢性鼻炎急性加重期治疗的成本效用分析。

IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY International Forum of Allergy & Rhinology Pub Date : 2024-09-20 DOI:10.1002/alr.23452
Matthew M Chu, Jack T Garcia, Ahmad R Sedaghat, George A Scangas, Katie M Phillips
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引用次数: 0

摘要

背景:对慢性鼻炎急性加重期(AECRS)的管理研究不足,此前也未对最具成本效益的 AECRS 管理方法进行过调查。本研究旨在确定最具成本效益的 AECRS 初始治疗策略:研究设计了一个决策树经济模型,比较了三种不同的AECRS初始治疗策略:观察、前期抢救药物或鼻内窥镜诊断(DNE)门诊。主要研究结果是单次 AECRS 的疾病负担,由健康效用值和症状持续时间决定。具有增量成本效益比的策略 结果:观察是最具成本效益的策略,每 QALD 的支付意愿为 137 美元。单向敏感性分析表明,当细菌感染作为 AECRS 病因的概率为结论时,观察比前期抢救药物更有效:当细菌感染的可能性较低时,观察是最经济有效的 AECRS 初始治疗策略。当 AECRS 的细菌病因概率超过 49.0% 时,前期抢救用药被证明是最具成本效益的策略。
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A cost utility analysis for the management of acute exacerbations of chronic rhinosinusitis.

Background: The management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost-effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost-effective strategy for the initial management of AECRS.

Methods: The study design consisted of a decision-tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost-effectiveness ratio < $50,000/quality-adjusted life year (QALY) or equivalently < $137/quality-adjusted life day (QALD) were considered cost-effective.

Results: Observation was the most cost-effective strategy at a willingness to pay of $137 per QALD. One-way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost-effective.

Conclusion: Observation is the most cost-effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost-effective strategy.

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来源期刊
CiteScore
11.70
自引率
10.90%
发文量
185
审稿时长
6-12 weeks
期刊介绍: International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.
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