ABSTRACT
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Subject(s)
Humans , Bronchial Provocation Tests/methods , Asthma/diagnosis , Withholding Treatment , Patient Safety , Methacholine Chloride , Forced Expiratory Volume , Asthma/drug therapyABSTRACT
INTRODUCCIÓN: Las unidades monográficas de asma (UMA) son consultas hospitalarias implementadas para lograr una mejoría clínica de los pacientes. Este estudio analiza su impacto sobre el control del asma y su coste-efectividad en comparación con las consultas ordinarias. MÉTODOS: Estudio de casos cruzados que incluyó a todos los pacientes que fueron atendidos por primera vez en la UMA de Lugo durante 2012. Se definió el «periodo-caso» como los 365días que siguieron a la primera visita en la UMA, y el «periodo-control» como los 365días que la antecedieron. Se calcularon los cambios en indicadores clínicos relevantes para el control del asma y se estimó la relación de coste-efectividad incremental (RCEI) por cada paciente adicional que fue controlado y por cada año de vida ajustado por calidad (AVAC). RESULTADOS: El porcentaje de pacientes (n = 83, edad media 49 ± 15,2 años; 60,2% mujeres) controlados aumentó del 41 al 86%. El resultado del test de control del asma mejoró desde 18,7 ± 4,6 hasta 22,6 ± 2,3 (p < 0,05) y el FEV1 se elevó desde 81,4% ± 17,5 hasta 84,4% ± 16,6 (p < 0,05). Las exacerbaciones, hospitalizaciones y visitas a urgencias disminuyeron un 75, un 78 y un 75%, respectivamente. La utilización de combinaciones CI/LABA decreció del 79,5% al 41%. El uso de otros fármacos aumentó: anticolinérgicos del 3,6 al 16,9%, CI en monoterapia del 3,6 al 45,8%, y omalizumab del 0 al 6%. Las RCEI por paciente controlado y por AVAC ganado fueron de 1.399 y 6.876 €, respectivamente (perspectiva social). CONCLUSIONES: La atención en una UMA es coste-efectiva y tiene un impacto beneficioso sobre el control del asma
INTRODUCTION: Asthma clinics (AC) are hospital outpatient services specialising in the management of asthma. In this study, we analysed the impact of these clinics on asthma management and their cost effectiveness in comparison with standard outpatient services. METHODS: A case cross-over study in which all new patients seen in the AC of Lugo in 2012 were included. The case period was defined as one year following the first visit to the AC; the control period was defined as the preceding year. We calculated changes in clinical quality indicators for asthma management, and estimated the incremental cost-effectiveness ratio (ICER) for each additional patient treated and for each quality-adjusted life year (QALY) RESULTS: The number of patients (n = 83, mean age 49 ± 15.2 years; 60.2% women) managed in the AC increased from 41% to 86%. The Asthma Control Test score increased from 18.7 ± 4.6 to 22.6 ± 2.3 (p < 0.05) and FEV1 increased from 81.4% ± 17.5 to 84.4% ± 16.6 (p < 0.05). The number of exacerbations, hospitalisations and visits to accident and emergency fell by 75%. The number of patients given combination LABA + ICS therapy fell from 79.5% to 41%. The use of other drug therapy increased: anticholinergics, from 3.6% to 16.9%; ICS in monotherapy, from 3.6% to 45.8%; and omalizumab, from 0% to 6%. ICERs per patient managed and per QALY gained were €1,399 and €6,876, respectively (social perspective). CONCLUSIONS: Treatment in ACs is cost-effective and beneficial in asthma management
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Asthma/diagnosis , Asthma/epidemiology , Asthma/prevention & control , Cost-Benefit Analysis/methods , Cost-Benefit Analysis , Cost Efficiency Analysis , Hospital Units/classification , Hospital Units , Efficiency, Organizational , Quality of Life , Health Care Costs , Cross-Over Studies , Retrospective Studies , Observational StudyABSTRACT
INTRODUCTION: Asthma clinics (AC) are hospital outpatient services specialising in the management of asthma. In this study, we analysed the impact of these clinics on asthma management and their cost effectiveness in comparison with standard outpatient services. METHODS: A case cross-over study in which all new patients seen in the AC of Lugo in 2012 were included. The case period was defined as one year following the first visit to the AC; the control period was defined as the preceding year. We calculated changes in clinical quality indicators for asthma management, and estimated the incremental cost-effectiveness ratio (ICER) for each additional patient treated and for each quality-adjusted life year (QALY) RESULTS: The number of patients (n=83, mean age 49 ± 15.2 years; 60.2% women) managed in the AC increased from 41% to 86%. The Asthma Control Test score increased from 18.7 ± 4.6 to 22.6 ± 2.3 (p<0.05) and FEV1 increased from 81.4% ± 17.5 to 84.4% ± 16.6 (p<0.05). The number of exacerbations, hospitalisations and visits to accident and emergency fell by 75%. The number of patients given combination LABA+ICS therapy fell from 79.5% to 41%. The use of other drug therapy increased: anticholinergics, from 3.6% to 16.9%; ICS in monotherapy, from 3.6% to 45.8%; and omalizumab, from 0% to 6%. ICERs per patient managed and per QALY gained were 1,399 and 6,876, respectively (social perspective). CONCLUSIONS: Treatment in ACs is cost-effective and beneficial in asthma management.
