Cost-effectiveness of a nurse-led telemonitoring intervention based on peak expiratory flow measurements in asthmatics: results of a randomised controlled trial

Background

Asthma is a chronic lung disease in which recurrent asthma symptoms create a substantial burden to individuals and their families. At the same time the economic burden associated with asthma is considerable.

Methods

The cost-effectiveness study was part of a single centre prospective randomised controlled trial comparing a nurse-led telemonitoring programme to usual care in a population of asthmatic outpatients. The study included 109 asthmatic outpatients (56 children; 53 adults). The duration of follow-up was 12 months, and measurements were performed at baseline, 4, 8, and 12 months. Patients were asked to transfer their monitor data at least twice daily and by judging the received data and following a stepwise intervention protocol a nurse was able to act as the main caregiver in the intervention group. In both groups the EQ-5D and the SF-6D were used to obtain estimates of health state utilities. One year health care costs, patient and family costs, and productivity losses were calculated. The mean incremental costs were weighted against the mean incremental effect in terms of QALY.

Results

The study population generally represented mild to moderate asthmatics. No significant differences were found between the groups with regard to the generic quality of life. Overall, the mean health care costs per patient were higher in the intervention group than in the control group. The intervention costs mainly caused the cost difference between the groups. The intervention costs the society € 31,035/QALY gained with regard to adults and with regard to children € 59,071/QALY gained.

Conclusion

If the outcome is measured by generic quality of life the nurse-led telemonitoring programme is of limited cost-effectiveness in the study population. From the societal perspective the probability of the programme being cost-effective compared to regular care was 85% at a ceiling ratio of € 80,000/QALY gained among the adults and 68% among the children. A decrease in the price of the asthma monitor will substantial increase the probability of the programme to be cost-effective.

Trial registration

Number: NCT00411436     

Muscle computed tomography in adult-onset acid maltase deficiency

Nine patients with adult-onset acid maltase deficiency (Pompe's disease) were examined clinically and with computed tomography (CT). The CT scan showed early and severe involvement of the muscles of trunk and thighs, with selective sparing of the tensor fasciae latae, short head of biceps femoris, gracilis, and sartorius muscles. Shoulder and leg muscles were less affected. The disease spread over the years from trunk to extremities. Muscle strength and CT findings were positively correlated. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:398–400, 1998.     

倾斜试验中血管迷走性晕厥患者血流动力学和神经激素的变化

目的探讨血管迷走性晕厥患者倾斜试验中血流动力学和神经激素的变化及晕厥触发机制.方法倾斜试验采用平卧10 min和倾斜80°直立30 min.试验阳性标准为晕厥先兆伴收缩期血压<90mm Hg(1 mmHg=0.133 kPa)和/或心率<60次/min.超声心动图于基础平卧,直立2 min和每隔3 min直至试验结束时连续记录左心室收缩末期内径(LVESD),左心室舒张末期内径(LVEDD),短轴缩短分数(SF)和心排出量(CO).同时测量儿茶酚胺血浆浓度.Ⅰ组为正常自愿者且倾斜试验阴性者8例,Ⅱ组为原因不明晕厥伴倾斜试验阴性者8例,Ⅲ组为原因不明晕厥伴倾斜试验阳性者16例.结果3组间年龄、性别以及基础状态下心率、平均动脉压、左心室内径、SF、CO和儿茶酚胺血浆浓度差别不明显.Ⅰ组和Ⅱ组完成了30 min直立试验,Ⅲ组出现阳性反应时间为(10±4)min.直立时各组发生的改变为(1)Ⅰ组和Ⅱ组虽心率明显增加,但血压稳定.Ⅲ组心率增快和血压逐渐下降,终止试验时心率由(110±22)次/min突然降至(82±16)次/min,平均动脉压由(78±14)mmHg降至(50±9)mm Hg,10例为血管抑制性晕厥,6例为混合性晕厥;(2)Ⅰ组和Ⅱ组左心室内径,CO和SF变化不显著;Ⅲ组LVEJDD由基础时(47±5)mm减至(36±6)mm,LVESD由(32±4)mm减至(22±5)mm;SF由(31±2)%增至(39±4)%,与前两组比较差别有显著性;(3)LVEDD和LVESD降低速率Ⅲ组明显大于Ⅰ组和Ⅱ组;(4)肾上腺素浓度在Ⅲ组明显高于前两组,由基础时(18±10)pg/ml达结束时(126±80)pg/ml,去甲肾上腺素在3组均有增高但组间比较无差别.结论血管迷走性晕厥患者倾斜试验中血流动力学和血浆儿茶酚胺浓度发生明显异常改变;左心室容量降低伴肾上腺素异常分泌和SF增强而激发迷走神经反射可能是触发晕厥的主要机制.