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      What do parents want from their child’s asthma treatment?

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          Nearly 5 million children in the United States are affected by asthma, which is more than 5% of the population younger than 18 years. In children four years or younger, the prevalence increased 160% from 1980 to 1994. There are several effective drugs that relieve the symptoms of asthma and others are currently being developed, but even when these medications are prescribed, they may be underutilized because parents fear the possibility of adverse events. Up to now there is no knowledge which are the main drivers of caregiver’s preferences for a safe and effective medication for preschool children in general. The study population was caregivers with children aged 4 years or below. Sample size was 42; results were checked by Monte Carlo simulation.

          Material and methods

          For a conjoint analysis a status quo treatment and hypothetical treatment options were defined by four attributes: Episode-free days, risk of exacerbation, information available for the long-term impact of the treatment, and out-of-pocket expenses. It was possible to use the status quo as the reference scenario, permitting to couch this ranking in terms of a decision to purchase the product. Relative importances for each product attribute as well as utility estimations for each attribute level were calculated.

          Results and discussion

          The overall result was that the most important feature for an asthma treatment, in this study, was the attribute of episode-free days. On a scale from 0 to 100 this attribute got the calculated relative importance of 44.2. In contrast to this finding is the relative importance of the attribute EXACERBATION, which only reached 16.2, which is the most unimportant attribute of the attributes offered. Even the variable INFORMATION available on long-term effects in children between 4 years and 14 years of age was more important than the side effects (19.2). Out-of-pocket expenses per month were the second most (relative) important attribute (20.5).

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          Most cited references 34

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          Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group.

          The role of long-acting, inhaled beta2-agonists in treating asthma is uncertain. In a double-blind study, we evaluated the effects of adding inhaled formoterol to both lower and higher doses of the inhaled glucocorticoid budesonide. After a four-week run-in period of treatment with budesonide (800 microg twice daily), 852 patients being treated with glucocorticoids were randomly assigned to one of four treatments given twice daily by means of a dry-powder inhaler (Turbuhaler): 100 microg of budesonide plus placebo, 100 microg of budesonide plus 12 microg of formoterol, 400 microg of budesonide plus placebo, or 400 microg of budesonide plus 12 microg of formoterol. Terbutaline was permitted as needed. Treatment continued for one year; we compared the frequency of exacerbations of asthma, symptoms, and lung function in the four groups. A severe exacerbation was defined by the need for oral glucocorticoids or a decrease in the peak flow to more than 30 percent below the base-line value on two consecutive days. The rates of severe and mild exacerbations were reduced by 26 percent and 40 percent, respectively, when formoterol was added to the lower dose of budesonide. The higher dose of budesonide alone reduced the rates of severe and mild exacerbations by 49 percent and 37 percent, respectively. Patients treated with formoterol and the higher dose of budesonide had the greatest reductions -- 63 percent and 62 percent, respectively. Symptoms of asthma and lung function improved with both formoterol and the higher dose of budesonide, but the improvements with formoterol were greater. In patients who have persistent symptoms of asthma despite treatment with inhaled glucocorticoids, the addition of formoterol to budesonide therapy or the use of a higher dose of budesonide may be beneficial. The addition of formoterol to budesonide therapy improves symptoms and lung function without lessening the control of asthma.
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            An economic evaluation of asthma in the United States.

            Asthma is a common chronic illness. Recently, increases in morbidity and mortality due to this disease have been reported. We studied the distribution of health care resources used for asthma in order to lay the groundwork for further policy decisions aimed at reducing the economic burden of this disorder. Estimates of direct medical expenditures and indirect costs (in 1985 dollars) were derived from data available from the National Center for Health Statistics. These cost estimates were projected to 1990 dollars. The cost of illness related to asthma in 1990 was estimated to be $6.2 billion. Inpatient hospital services represented the largest single direct medical expenditure for this chronic condition, approaching $1.6 billion. The value of reduced productivity due to loss of school days represented the largest single indirect cost, approaching $1 billion in 1990. Although asthma is often considered to be a mild chronic illness treatable with ambulatory care, we found that 43 percent of its economic impact was associated with emergency room use, hospitalization, and death. Nearly two thirds of the visits for ambulatory care were to physicians in three primary care specialties--pediatrics, family medicine or general practice, and internal medicine. Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.
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              Risk analysis: A quantitative guide

               D. VOSE,  D Vose (2008)

                Author and article information

                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                March 2007
                March 2007
                : 3
                : 1
                : 167-175
                Analytica International Untere Herrenstrasse 25, 79539 Loerrach, Germany
                Author notes
                Correspondence: Stefan Walzer Analytica International, Untere Herrenstr. 25, 79539 Loerrach, Germany Tel +49 7621 9339 1164 Fax +49 7621 9339 2164 Email stefan.walzer@ 123456access.unizh.ch
                © 2007 Dove Medical Press Limited. All rights reserved
                Original Research


                utility, health economics, discrete-choice analysis, conjoint analysis, preference study


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