Effectiveness of Asthma Care: The Asthma Policy Model

我们的总体目标是促进合理确定哮喘治疗的优先顺序。在过去的四年里，我们开发了哮喘政策模型，这是对哮喘临床管理的数学模拟。我们使用这一模型来估计健康和经济结果，并评估控制疾病的不同战略的成本效益。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，以完善该模型，将其应用于研究不足但高度脆弱的患者群体，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，改进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；我们将考虑新的药理学和非药理学干预措施；我们将完善该模型的干预效果和副作用的衡量标准；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进行一系列基于模型的政策评估：(1)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代价是什么？(2)为服务不足的人群中的患者开展哮喘药物治疗和疾病管理的综合计划是否具有成本效益？它可以同时改善临床结果，避免不必要的资源消耗，并降低总体成本吗？鉴于历史上在促进这些人群坚持治疗方面缺乏成功，结果对依从率有多敏感？(3)与毒性相关的生活质量问题对哮喘患者的结局、经济成本和吸入皮质类固醇治疗的成本效益有什么影响？这项研究汇集了哮喘流行病学和药物治疗(Weiss、Fuhlbrigge、Kitch和Moy博士)、环境暴露评估(Leaderer博士)、城市、少数族裔人口的疾病负担(Cloutier博士)、生物统计分析(昆茨博士)以及模拟建模和经济评估(Paltiel博士)的专家，以探索针对哮喘流行的成本效益解决方案。

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.