Effectiveness of Asthma Care: The Asthma Policy Model

哮喘护理的有效性：哮喘政策模型

• 批准号: 6473242
• 负责人: A. DAVID PALTIEL
• 金额: $ 51.04万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2005-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6473242
• 关键词: African American; Hispanic Americans; adolescence (12-20); allergens; asthma; behavioral /social science research tag; children; clinical research; computer simulation; cost effectiveness; health care cost /financing; health care model; health care policy; health care service utilization; human data; human middle age (35-64); human therapy evaluation; mathematical model; medically underserved population; middle childhood (6-11); outcomes research; patient care management; respiratory disease /disorder therapy; respiratory disorder chemotherapy; therapy compliance; young adult human (21-34)

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.

我们的广泛目标是在哮喘护理中促进合理的优先设置。在过去的四年中，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。我们已经使用该模型来估计健康和经济成果，并评估管理疾病的不同策略的成本效益。据我们所知，哮喘政策模型代表与哮喘相关的药物经济评估中的最新技术。现在，我们要求三年的资金来完善该模型，将其应用于研究不足但高度脆弱的患者人群，并解决新的临床和资源分配决策。我们的第一个具体目的是扩大哮喘政策模型，改善其对儿童和服务不足的患者人群的关注，并扩大其模拟治疗影响的能力：我们将扩大患者子群体的定义；我们将考虑新的药理学和非药物干预措施；我们将完善模型的干预功效和副作用的度量；我们将对干预措施的探索性评估，以提高依从性。我们的第二个具体目的是进行一系列基于模型的政策评估：（1）非遵守1997年NIH诊断和管理哮喘的临床和经济成本是什么？ （2）在服务不足人群中，哮喘药物治疗和疾病管理的综合计划是否会具有成本效益？它是否可以同时改善临床结果，避免不必要的资源消耗并降低整体成本？鉴于历史上缺乏成功促进这些人群遵守治疗的成功，结果对合规率的敏感程度如何？ （3）与毒性相关的，生活质量的关注对患者预后，经济成本以及吸入性皮质类固醇疗法的成本效益有什么影响？这项研究组装专家在哮喘流行病学和药物疗法方面（魏斯博士，福布里格格，厨房和莫伊博士），环境暴露评估（Leader），城市疾病的负担，少数民族人口（Cloutier博士），生物统计学分析（BioStatistical Analysis（博士）和经济评估（paltiel astriem for Paltemectie-Extiel astriel），以访问Paltemectiel（paltemectie-Extiel）。