目的:比较花生过敏儿童中益生菌佐剂与花生口服免疫疗法(PPOIT)与安慰剂(不治疗)联合给药的成本效益。
方法:前瞻性计划的成本-效果分析以及一项随机对照试验。
方法:皇家儿童医院,墨尔本,澳大利亚。
方法:招募时年龄在1-10岁的56名花生过敏儿童。
方法:每日剂量的益生菌鼠李糖乳杆菌CGMCC1.3724(NCC4007)和花生口服免疫治疗1.5年。
方法:从医疗保健系统的角度考虑费用,包括治疗和不良事件的费用。有效性结果包括持续无反应率(SU)和质量调整生命年(QALYs)。使用患者水平的数据分析了PPOIT与安慰剂的成本效益。从PPOIT治疗开始的时间范围是10年,包括1.5年的治疗(实际数据),4年治疗后随访(实际数据),以及此后4.5年的外推(建模)。
结果:与安慰剂相比,PPOIT的10年以上每位患者的医疗费用更高($A9355vs$A1031,p<0.001)。PPOIT组中超过一半的每位患者医疗保健费用(53%)归因于治疗交付,而其余费用可归因于不良事件.PPOIT组的两种有效性指标均优于PPOIT组:PPOIT在10年内的平均SU率为54%,安慰剂为6%(p<0.001);PPOIT在10年内的QALY为9.05,安慰剂为8.63(p<0.001)。总的来说,与安慰剂相比,PPOIT每年获得的SU成本为A1694美元(范围为A1678美元,A1709美元),每增加QALY的成本为A19386美元(范围为A19024美元,A19774美元)。
结论:与未治疗相比,使用PPOIT获得的每QALY的成本约为20000美元(10000英镑),远低于常规价值判断阈值$50000(25000英镑)。因此认为物有所值($A1=约0.5英镑)。
背景:澳大利亚新西兰临床试验注册ACTRN12608000594325;后结果。
To compared the cost-effectiveness of coadministration of a probiotic adjuvant with peanut oral immunotherapy (PPOIT) with placebo (no treatment) in children with peanut allergy.
Prospectively planned cost-effectiveness analysis alongside a randomised control
trial.
The Royal Children\'s Hospital, Melbourne, Australia.
56 children with peanut allergy aged 1-10 years at recruitment.
A daily dose of probiotic Lactobacillus rhamnosus CGMCC 1.3724 (NCC4007) and peanut oral immunotherapy administered for 1.5 years.
Costs were considered from a healthcare system perspective and included costs of treatment delivery and adverse events. Effectiveness outcomes included rate of sustained unresponsiveness (SU) and quality-adjusted life years (QALYs). The cost-effectiveness of PPOIT versus placebo was analysed using patient-level data. Time horizon was 10 years from commencement of PPOIT treatment, comprising 1.5 years of treatment (actual data), 4 years of post-treatment follow-up (actual data), and 4.5 years of extrapolation thereafter (modelling).
Healthcare cost per patient over 10 years was higher for PPOIT compared with placebo ($A9355 vs $A1031, p<0.001). Over half of the per patient healthcare cost (53%) in the PPOIT group was attributable to treatment delivery, while the remaining cost was attributable to adverse events. Both measures of effectiveness were superior in the PPOIT group: the average SU rate over 10 years was 54% for PPOIT versus 6% for placebo (p<0.001); QALYs over 10 years were 9.05 for PPOIT versus 8.63 for placebo (p<0.001). Overall, cost per year of SU achieved was $A1694 (range $A1678, $A1709) for PPOIT compared with placebo, and cost per additional QALY gained was $A19 386 (range $A19 024, $A19 774).
Cost per QALY gained using PPOIT compared with no treatment is approximately $A20 000 (£10 000) and is well below the conventional value judgement threshold of $A50 000 (£25 000) per QALY gained, thus deemed good value for money ($A1= £0.5 approximately).
Australian New Zealand Clinical Trials Registry ACTRN12608000594325; Post-results.