Impact of inhaled corticosteroids on acute asthma hospitalization in Sweden 1978 to 1991.
Impact of inhaled corticosteroids on acute asthma hospitalization in Sweden 1978 to 1991.
复制标题
1978 年至 1991 年瑞典吸入皮质类固醇对急性哮喘住院的影响。
DOI：
10.1097/00005650-199612000-00004
复制
发表时间：
1996
期刊：
影响因子：
3
通讯作者：
G. Boman
中科院分区：
文献类型：
--
作者：
U. Gerdtham;P. Hertzman;B. Jönsson;G. Boman
目标
临床研究发现，吸入糖皮质激素治疗哮喘患者可以减少住院治疗的需要。这项研究的目的是确定在瑞典现有的卫生保健统计数据中是否可以观察到这种关系，如果可以建立这种关系，它意味着什么卫生经济后果。
方法
根据1978年至1991年期间14个医疗行政区的急性住院数据--即急性躯体住院诊所的卧床天数--以及抗哮喘药物的销售情况，进行了一项回溯性研究，涉及600万人(占瑞典人口的71%)。这些数据在多元回归分析中被分析，其中时间和横截面数据被汇集在一起。卧床天数的变化由三个变量解释：(1)吸入皮质类固醇的销售额，(2)急性躯体住院护理中的总卧床天数，以及(3)作为哮喘患病率替代变量的吸入性支气管扩张剂的销售额。
结果
从1978年到1985年，14个县议会因哮喘而住院的总天数没有出现任何上升或下降的趋势。然而，1985年后，尽管估计哮喘患病率有所上升，但仍有显著下降趋势。吸入性皮质类固醇销售量的增加与哮喘患者卧床天数的减少显著相关(P<；0.01)。使用的模型表明，吸入皮质类固醇的销售额每天增加1个限定日剂量(DDD)，1000名居民在研究期间每1000名居民的急性住院护理中哮喘平均减少1.5个床日。
结论
临床试验发现，吸入皮质类固醇治疗哮喘患者可以改善哮喘控制，减少住院需求，似乎在临床实践中实现了这一点。吸入性皮质类固醇给保健系统增加的费用被急性躯体医院护理费用的减少所抵消。
OBJECTIVES
In clinical studies, it has been found that treating asthmatic patients with inhaled corticosteroids can reduce the need for in-patient care. The purpose of this study was to determine if such a relationship could be observed in available health-care statistics in Sweden and, if such a relationship could be established, what health economic consequences it implied.
METHODS
A retrospective study was conducted using regional data on acute hospitalization-ie, number of bed-days in acute somatic in-patient care clinics-and sales of anti-asthmatic drugs from 14 health-care administrative regions, covering 6 million people (71% of the Swedish population) between 1978 and 1991. The data were analyzed in multiple regression analyses where time- and cross-section data were pooled. The variation in bed-days was explained by three variables: (1) the sales of inhaled corticosteroids, (2) the total number of bed-days within acute somatic in-patient care, and (3) the sales of inhaled bronchodilators, which were used as a proxy variable for asthma prevalence.
RESULTS
The total number of bed-days due to asthma in the 14 county councils did not show any upward or downward trend between 1978 and 1985. However, after 1985, there was a significant downward trend despite an increase in estimated asthma prevalence. Increased sales of inhaled corticosteroids were significantly correlated (P < 0.01) with a reduction in bed-days due to asthma. The model used indicated that an increase in sales of inhaled corticosteroids by 1 defined daily dose (DDD) per day and 1,000 inhabitants gave, on average over the study period, a reduction of 1.5 bed-days for asthma in acute in-patient care per 1,000 inhabitants.
CONCLUSIONS
Clinical trial findings that treating asthmatic patients with inhaled corticosteroids improves asthma control and reduces the need for hospitalization, seem to be realized in clinical practice. The increased costs of inhaled corticosteroids to the health-care system were more than offset by a reduction in the costs for acute somatic hospital care.