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The clinical economic evaluation of results of therapy of acute and recurrent obstructive bronchitis


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Abstract

The possibility of forecasting clinical and economic components of disease was investigated on the example of transition of obstructive and recurrent obstructive bronchitis into bronchial asthma in children in conditions of concrete clinical practice and optimal choice of treatment. The diagnostic tests were suggested to be applied to detect intracellular agents under recurrent cases of obstruction of bronchi using Markovian modeling. The materials involved into analysis were medical documentation (medical histories of patients with obstructive bronchitis), statistical reports of population health related to bronchopulmonary diseases, tariffs of medical services rendering, commodity invoices of distributors of pharmaceuticals. The retrospective study was carried out using data extracting from 2259 medical histories into specially developed sheets with following analysis of structure of medical prescriptions, tactics of physician, evaluation of therapeutic effectiveness and calculation of treatment costs. The study was carried out three medical organizations of Nizhniy Novgorod in 2008-2011. In the course of study forecasting of development of bronchial asthma in children after acute and recurrent obstructive bronchitis in conditions of concrete clinical practice was established. The cases of development of bronchial asthma under application of necessary diagnostic measures detecting intracellular agents in patients with acute and recurrent obstructive bronchitis were prognosticated. The costs of treatment of patients with bronchial asthma in conditions of concrete clinical practice and optimal choice of treatment were evaluated. The application of Markovian modeling to the given forecasting time-frame resulted in decreasing of number of cases of development of bronchial asthma under optimal choice of treatment up to 6.3 times as compared with methods of therapy applied nowadays. The corresponding costs of treatment decreased up to 4.4 times. Hence, application of Markovian modeling permits forecasting clinical and economic effectiveness of various methods of treatment and to substantiate choosing more expensive method of treatment of disease under its maximal effectiveness.


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