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对非注射性上腺素的健康经济分析与肌肉内上腺素相比
Marcus S Shaker1, John Oppenheimer2, Nicholas L Rider3
1Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
概括
非注射性上腺素,如鼻腔或舌下形式,与肌内上腺素相比,是治疗过敏反应的经济有效替代方案. 然而,携带额外的上腺素装置并不具有成本效益.
科学领域:
- 过敏和免疫学 过敏和免疫学
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 非注射性上腺素配方解决了管理过敏反应的关键未满足需求.
- 鼻内上腺素已获得批准,语言下形式正在开发中,而吸入上腺素在过敏反应中的作用仍未得到充分研究.
- 这些非传统上腺素输送方法的成本效益在很大程度上是未知的.
研究的目的:
- 进行成本效益分析,比较非注射性上腺素替代品与传统肌内上腺素用于过敏反应治疗.
- 评估鼻内,舌下和吸入上腺素在治疗严重过敏反应中的经济可行性.
主要方法:
- 使用马尔科夫队列分析来建模各种非注射性上腺素形式的成本效益.
- 假设包括鼻腔/舌下形式的死亡风险显著降低,由于证据有限,吸入上腺素的风险更高.
主要成果:
- 鼻内或舌下上腺素证明了成本效益,产生了积极的净货币收益和83,748美元/QALY的增量成本效益比,边际成本为4.4美元.
- 与吸入性上腺素相比,肌内上腺素的成本效益较高,如果死亡风险降低,这种药物可能会变得具有成本效益.
- 替换第二个自动注射器的非注射型是具有成本效益的,但添加额外的非注射型设备不是.
结论:
- 非注射性上腺素路径可以在过敏反应中具有成本效益,如果它们不会显著增加死亡风险.
- 与非注射形式一起携带多余的上腺素自注射器是不具有成本效益的,因为多余的设备包装的额外成本.
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