Effectiveness of Asthma Care: The Asthma Policy Model

我们的广泛目标是促进哮喘护理的合理优先设置。在过去的四年里，我们开发了哮喘政策模型，一个哮喘临床管理的数学模拟。我们已经使用该模型来估计健康和经济结果，并评估管理该疾病的不同策略的成本效益。据我们所知，哮喘政策模型代表了哮喘相关药物经济学评估的最新水平。我们现在要求三年的资金来完善模型，将其应用于研究不足但非常脆弱的患者群体，并解决新的临床和资源分配决策。我们的第一个具体目标是扩展哮喘政策模型，改善其对儿童和服务不足的患者群体的关注，并扩大其模拟治疗影响的能力：我们将扩大患者亚群的定义；我们将考虑新的药物和非药物干预措施；我们将完善模型对干预效果和副作用的测量；我们将对干预措施进行探索性的“假设”评估，以提高对治疗的依从性。我们的第二个具体目标是执行一系列基于模型的政策评估：(1)在美国，不遵守1997年美国国立卫生研究院哮喘诊断和管理指南的临床和经济成本是什么？(2)在服务不足的人群中，哮喘药物治疗和疾病管理的综合方案是否具有成本效益？它能否同时改善临床结果，避免不必要的资源消耗，并降低总体成本？鉴于历史上在促进这些人群的治疗依从性方面缺乏成功，结果对依从率有多敏感？(3)毒性相关的生活质量问题对哮喘吸入皮质类固醇治疗的患者结局、经济成本和成本-效果有何影响？这项研究汇集了哮喘流行病学和药物治疗方面的专家。Weiss, Fuhlbrigge, Kitch, and Moy)，环境暴露评估（Leaderer博士），城市疾病负担，少数民族人群（Cloutier博士），生物统计分析（Kuntz博士），以及模拟建模和经济评估（Paltiel博士），以探索具有成本效益的哮喘流行解决方案。

Our broad objective is to promote reasoned priority setting in asthma care. Over the last four years, we have developed the Asthma Policy Model, a mathematical simulation of the clinical management of asthma. We have used this model to estimate health and economic outcomes and to evaluate the cost-effectiveness of different strategies for managing the disease. To our knowledge, the Asthma Policy Model represents the state of the art in asthma-related pharmacoeconomic evaluation. We now request three years of funding to refine the model, to apply it to understudied yet highly vulnerable patient populations, and to address new clinical and resource allocation decisions. Our first Specific Aim is to expand the Asthma Policy Model, improving its focus on children and underserved patient populations and broadening its capacity to simulate the impact of treatment: we will enlarge the definition of patient sub-populations; we will consider new pharmacologic and non-pharmacologic interventions; we will refine the model's measures of intervention efficacy and side-effects; and we will conduct exploratory, "what-if" evaluations of interventions to improve adherence to therapy. Our second Specific Aim is to perform a series of model-based policy evaluations: (1) What are the clinical and economic costs of non- adherence to the 1997 NIH Guidelines for the Diagnosis and Management of Asthma in the United States? (2) Would a comprehensive program of asthma pharmacotherapy and disease management for patients in underserved populations be cost-effective? Could it simultaneously improve clinical outcomes, avoid unnecessary resource consumption, and reduce overall costs? Given the historical lack of success in promoting adherence to therapy in these populations, how sensitive are results to compliance rates? (3) What impact do toxicity-related, quality-of-life concerns have on patient outcomes, economic costs, and the cost-effectiveness of inhaled corticosteroid therapy in asthma? This research assembles experts in asthma epidemiology and pharmacotherapy (Drs. Weiss, Fuhlbrigge, Kitch, and Moy), environmental exposure assessment (Dr. Leaderer), burden of disease in urban, minority populations (Dr. Cloutier), biostatistical analysis (Dr. Kuntz), and simulation modeling and economic evaluation (Dr. Paltiel) to explore cost-effective solutions to the asthma epidemic.