The Cost Effectiveness of School-Based Supervised Asthma Therapy

学校监督哮喘治疗的成本效益

• 批准号: 8413990
• 负责人: Lynn B Gerald
• 金额: $ 46.42万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-10 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8413990
• 关键词: Academy; Adherence; Adopted; Adoption; Adrenal Cortex Hormones; African American; American; American Lung Association; Arizona; Asthma; Breathing; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child health care; Chronic; Clinical Trials; Collaborations; Communities; Cost Effectiveness Analysis; Data; Development; Diagnosis; Directly Observed Therapy; Education; Effectiveness; Ensure; Evaluation; Event; Focus Groups; Gold; Guidelines; Health; Health Resources; Hispanics; Hypersensitivity; Immunology; Intervention; Interview; Juniper; Low income; Measures; Medicine; Modeling; Monitor; Morbidity - disease rate; Parents; Participant; Pharmaceutical Preparations; Policy Maker; Population; Population Heterogeneity; Prevention program; Process; Program Effectiveness; Provider; Public Health; Publishing; Quality of life; Quality-Adjusted Life Years; Questionnaires; Randomized Controlled Trials; Recommendation; Reference Standards; Research; Research Personnel; Schools; Students; Supervision; Symptoms; System; Time; Tuberculosis; base; computerized data processing; cost effective; cost effectiveness; disorder prevention; elementary school; experience; health care service utilization; improved; informant; inner city; medication compliance; programs; public health relevance; school health; screening; secondary outcome; treatment as usual

DESCRIPTION (provided by applicant): Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs. Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence. A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools. This study aims to evaluate: (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system; (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program's implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation. Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma. This project will provide critical information regarding the program's value, feasibility, and sustainability within communities with large asthma burden. In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations. With this information, policy makers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health.

描述（由申请人提供）：哮喘是儿童中常见的慢性疾病，与显著的发病率相关。由于药物不依从性是发病率过高的一个重要原因，国家哮喘教育和预防计划指南呼吁制定更有效的依从性计划。学校代表了一个合乎逻辑的设置，在那里坚持程序可以达到市中心，低收入和种族多样化的人群，有最高的发病率和最低的坚持。最近的一项临床试验表明，在学校对日常控制药物进行监督治疗 在城市低收入小学中，主要是非洲裔美国学生的药物依从性和哮喘控制增加。 本研究旨在评价：（1）在真实的世界条件下，通过对500名主要为西班牙裔的大城市学校系统的哮喘儿童进行的随机对照试验，评估社区管理的监督治疗的有效性;（2）从社会角度，使用获得的每质量调整生命年（QALY）美元，评估监督治疗的成本效益;以及3）通过全面的过程评估来评估项目的实施保真度、最佳交付机制和结构效度。监督治疗被认为是一种有效且具有成本效益的机制，可以改善哮喘学生人群水平的哮喘控制。 该项目将提供有关该计划的价值，可行性， 和可持续性在社区与大哮喘负担。此外，它将提供重要的建议，以加快采用基于指南的照顾哮喘的学生在城市，低收入和种族多样化的人群。有了这些信息，政策制定者可以通过采取有效地最大限度地提高儿童健康的计划来优化稀缺的公共卫生资源的使用。