Cost-effectiveness of school-based asthma screening in an urban setting

被引:17
作者
Gerald, Joe K. [1 ]
Grad, Roni [3 ]
Bailey, William C. [4 ]
Gerald, Lynn B. [2 ,3 ]
机构
[1] Univ Arizona, Div Community Environm & Policy, Mel & Enid Zuckerman Coll Publ Hlth, Tucson, AZ 85724 USA
[2] Univ Arizona, Div Hlth Promot Sci, Mel & Enid Zuckerman Coll Publ Hlth, Tucson, AZ 85724 USA
[3] Univ Arizona, Arizona Resp Ctr, Tucson, AZ 85724 USA
[4] Univ Alabama Birmingham, Sch Med, Lung Hlth Ctr, Birmingham, AL USA
关键词
Asthma; screening; case detection; childhood asthma; cost-effectiveness; quality of life; economic analysis; Markov modeling; HEALTH-CARE SERVICES; QUALITY-OF-LIFE; ELEMENTARY-SCHOOL; CHILDHOOD ASTHMA; CHILDREN; PREVALENCE; MEDICAID; THERAPY; EMERGENCY; SEVERITY;
D O I
10.1016/j.jaci.2009.12.984
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Much has been done to promote population-based childhood asthma screening; however, concerns remain regarding its cost-effectiveness. Objectives: To conduct a cost-effectiveness analysis of school-based asthma screening strategies. Methods: A 5 health state Markov approach (symptom-free, symptom, exacerbation recovery, emergency department, and hospitalization day) was used to evaluate school-based screening in a simulated population of urban elementary-age school children. Two questionnaire and 2 multistage strategies incorporating spirometry or spirometry with exercise testing were evaluated from the societal perspective by using 365 daily cycles. The outcome was 2006 dollars per quality-adjusted life year (QALY). Results: The most efficient strategy identified children with previously diagnosed but poorly controlled asthma at a cost of $150,000 per QALY (95% CI, $65,800-$318,000). Uncertainty surrounding the cost-effectiveness estimate was primarily a result of the symptom day preference weight estimate (44%), the probability of confirmation after screening (17%), the adequacy of asthma control in the population (9%), and the estimated treatment effect on symptoms (6%). Screening generated an additional 21 symptom-free day equivalents per child identified with previously diagnosed but not well controlled asthma and led to $85.55, $12.36, and $2.58 in additional screening, daily treatment, and indirect costs and $5.01 less in emergency department and hospitalization costs. Conclusion: Population-based asthma screening is not cost-effective at $50,000 per QALY and has only a 20% chance of being cost-effective at $100,000 per QALY. The most efficient approach is to screen for previously diagnosed but poorly controlled asthma. Linking screening with better treatment, and long-term adherence strategies might yield future cost-effective approaches. (J Allergy Clin Immunol 2010;125:643-50.)
引用
收藏
页码:643 / 650
页数:8
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