中国治疗慢性乙型肝炎的成本-效果的系统评价

目的本研究旨在对中国现有慢性乙型肝炎干预措施的经济学分析研究进行系统评价.方法计算机检索MEDLINE和中国国内4个最大的电子数据库;同时筛检了纳入研究的参考文献,纳入所有慢性乙型肝炎干预措施的经济学评价研究.使用一个由25项组成的总量表评价纳入文献的质量.质量评价和资料提取由两名评价员独立进行.结果纳入19个完整的经济学评价和成本研究,其中14个研究的总体质量为22～44 分,7个研究为45～61分.大多数研究充分描述了干预措施的临床效果,但仅50%的研究充分报道了成本鉴定、测量和赋值三个过程.部分研究的数据分析存在问题,特别是敏感性分析和贴现两个方面.10个研究比较了拉米夫定、干扰素和常规治疗1年(或6个月)的效果,结果显示拉米夫定总体上成本-效果更好.3个研究比较了干扰素和常规治疗的长期效果(30年),干扰素治疗方案相对于常规治疗可节约成本,提高疗效.另3个研究比较了干扰素与其他不常用的抗病毒药物,结果其成本-效果不同.2项成本研究结果显示,随着疾病严重程度加剧,医疗成本占总成本比例和总成本均增加.结论在现有干预措施中,拉米夫定的短期成本-效果相对较好.干扰素的长期成本-效果相对常规治疗更好.但各干预措施的长期成本-效果尚不能根据现有研究得到可靠证实.此外,方法学质量,特别是成本的测算较低影响了研究结果的可靠性,有必要提高原始研究报告的质量.总之,运用现有结果进行决策时需仔细考虑.

Cost-effectiveness of Treatment of Chronic Hepatitis B in China: A Systematic Review

Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China.Methods We searched MEDLINE and the four largest Chinese electronic databases.The references of eligible studies were also screened.Economic evaluations of any type,which studied interventions for hepatitis B,were eligible for inclusion.A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies.The overall quality score was calculated against 100 points to indicate the risk of bias.Quality appraisal and data extraction were conducted by two independent reviewers.Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 2544 points,and seven scored 4561 points.Most studies adequately documented effectiveness of interventions.However,the costs of interventions were not well reported in over 50% of studies.Many studies inadequately conducted data analysis,particular in sensitivity analysis and discounting.Ten studies compared lamivudine with interferon or conventional therapy for 1-year(or 6-month) effects,which indicated that lamivudine was generally cost-effective.Three evaluations studied 30-year outcomes of interferon compared with conventional therapy,which suggested that interferon usually saved additional costs and years of life.Another three studies compared interferon with less frequently used antiviral agents,however the comparative cost-effectiveness varied.Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions,lamivudine is cost effective for short-term effects.Interferon is superior to conventional therapy for long-term outcomes.However,the long-term economic outcomes cannot be justified by the current evidence.Quality of methods,particularly,that of costing and analytical methods,is a major limitation.There remains a strong need to improve the quality of reporting.Careful considerations should be paid before applying the results to decision making.