Modeling asthma exacerbations through lung function in children

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:130

Article

Wu, Ann Chen^1,2,3  Gregory, Martin⁴  Kymes, Steven⁴  Lambert, Dennis⁴  Edler, Joshua⁴  Stwalley, Dustin⁴  Fuhlbrigge, Anne L.⁵ 

[1] Harvard Univ, Dept Populat Med, Sch Med, Boston, MA 02215 USA

[2] Harvard Pilgrim Hlth Care Inst, Ctr Child Hlth Care Studies, Dept Populat Med, Boston, MA USA

[3] Childrens Hosp, Dept Pediat, Boston, MA 02115 USA

[4] Washington Univ, Sch Med, Ctr Econ Evaluat Med, St Louis, MO 63130 USA

[5] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA

关键词: Asthma;    pediatric patients;    lung function;    FEV1% predicted;    hospitalizations;    emergency department visits;    model;   

DOI  :  10.1016/j.jaci.2012.08.009

来源: Elsevier

【 摘 要 】

Background: Formal economic evaluation using a model-based approach is playing an increasingly important role in health care decision making. Objective: To develop a model by using an objective measure of lung function- prebronchodilator FEV1 as a percent of predicted (FEV1% predicted)-as the primary independent factor to predict the frequency of adverse events related to the exacerbation of asthma on a population level. Methods: We developed a Markov simulation model of childhood asthma by using data from the Childhood Asthma Management Program. The primary outcomes were the result of asthma exacerbations defined as hospitalizations, emergency department (ED) visits, and the need for oral corticosteroid therapy. Predicted monthly frequencies for each acute event were based on negative binomial regression equations estimated from the placebo arm of the Childhood Asthma Management Program with covariates of age, prebronchodilator FEV1% predicted, time in study, prior hospitalizations, and prior nocturnal awakenings. Results: Simulated versus observed mean number of acute events were similar within the placebo and treatment groups. While the trial demonstrated treatment effects of 48% reduction in hospitalizations, 46% reduction in ED visits, and 44% reduction in the need for oral corticosteroid therapy at 48 months, the model simulated similar reductions of 49% in hospitalizations, 41% in ED visits, and 46% in the need for oral corticosteroid therapy. Conclusions: Our findings suggest that longitudinal intervention effects may be modeled through FEV1% predicted to estimate hospitalizations, ED visits, and need for oral corticosteroid therapy in childhood asthma for planning and evaluation purposes. (J Allergy Clin Immunol 2012;130:1065-70.)

【 授权许可】

Free