Modeling asthma exacerbations through lung function in children - 31/10/12
, Martin Gregory, BA c, Steven Kymes, PhD c, Dennis Lambert, PhD c, Joshua Edler, MS c, Dustin Stwalley, MA c, Anne L. Fuhlbrigge, MD, MS d
Corresponding author: Ann Chen Wu, MD, MPH, Department of Population Medicine, Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.Abstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, pediatric patients, lung function, FEV1% predicted, hospitalizations, emergency department visits, model
Abbreviations used : CAMP, ED, ICS
Plan
| This work was supported by a grant from the National Heart, Lung, and Blood Institute (The Effectiveness of Pharmacogenetic Testing in Asthma, grant no. K08 HL088046, PI: Wu). The Center for Economic Evaluation in Medicine is supported by the Clinical and Translational Science Award program of the National Center for Research Resources at the National Institutes of Health (grant no. UL1 RR024992). |
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| Disclosure of potential conflict of interest: J. Edler and D. Lambert have been supported by one or more grants from the National Heart, Lung, and Blood Institute (NHLBI). D. Stwalley has been supported by one or more grants from Harvard Pilgrim Healthcare. A. Fuhlbrigge has been supported by one or more grants from the NHLBI; has received support for travel from the NHLBI’s Data Coordinating Center; is a Board member for Merck; has consultancy arrangements with Merck, GlaxoSmithKline, ICON Medical Imaging, Sunovion, the Lovelace Respiratory Research Institute, Dmagi, and the NHLBI; and has received one or more grants from or has one or more grants pending with Agency for Healthcare Research and Quality. M. Gregory has been supported by one or more grants from Washington University. S. Kymes has been supported by one or more grants from Harvard Pilgrim Healthcare; has consultancy arrangements with Pfizer, Genentech, and Treeage; has received one or more grants from or has one or more grants pending with Pfizer and with Genentech; and has received one or more payments for travel/accommodations/meeting expenses from Pfizer. A. C. Wu has been supported by one or more grants from the National Institutes of Health. |
Vol 130 - N° 5
P. 1065-1070 - novembre 2012 Retour au numéro
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