Abstract
Objetivos
Estimar el coste y conocer el manejo de una crisis asmática en atención primaria.
Diseño
Estudio observacional, prospectivo.
Emplazamiento
Diez consultas de 9 centros de atención primaria de 5 provincias (Asturias, Barcelona, Cádiz, Madrid y Valencia).
Participantes
Diez médicos de familia que incluyeron, secuencialmente, a 133 pacientes con una crisis de asma.
Mediciones principales
Se calcularon los costes directos e indirectos que supone una crisis de asma. El episodio se trató como habitualmente venía haciéndolo cada médico, sin que la intervención estuviera previamente definida en el protocolo del estudio.
Resultados
Se observaron un 43,6% de crisis leves, un 43,6% de crisis moderadas y un 12,8% de crisis graves. El 17,2% de estas últimas ocurrieron en pacientes con asma intermitente. Cuanto más grave era la crisis, menor era el tratamiento preventivo anterior a ella. El coste medio de una crisis asmática fue de 166,7 € (intervalo de confianza [IC] del 95%, 146,5-192,3), el 80% (132,4 €; IC del 95%, 122,7-143,8) debido a costes directos y el 20% (34,3 €, (IC del 95%, 17- 56,2) a costes indirectos. La opción más económica de manejo de una crisis fue «cambiar el tratamiento, realizar una prueba diagnóstica y 2 visitas médicas».
Conclusiones
El coste medio de una crisis asmática tratada en atención primaria fue de 166,7 € (IC del 95%, 146,5-192,3), el 80% debido a costes directos y el 20% a costes indirectos.
Palabras clave: Asma, Utilización de recursos, Atención primaria, Crisis asmática
Abstract
Objectives
To estimate the cost and characterize the management of asthma attacks in primary care.
Design
Prospective, observational study of 1 year’s duration.
Setting
10 physician’s offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain.
Participants
10 family physicians who saw 133 consecutive patients with an asthma attack.
Method
Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians’ habitually used procedures; the study protocol did not specify any predetermined intervention.
Results
The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was €166.7 (95% CI, 146.5-192.3); 80% (€132.4) (95% CI, 122.7-143.8) were direct costs and 20% (€34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician.
Conclusions
Mean cost of each asthma attack treated in primary care was €166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs.
Key words: Asthma, Resource utilizations, Primary care, Asthma attack
Footnotes
Este estudio se ha realizado con la colaboración del Departamento de Farmacoeconomía de GlaxoSmithKline España, que ha dado su apoyo al proyecto en el análisis de los datos, especialmente en cuanto a los aspectos económicos que el trabajo contempla sobre el coste de las crisis de asma
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