上市后药物的经济学评价

本重点讨论了药物经济学的特征和常用的评价方法。药品上市后为大量临床实践提供了观察治疗效果和不良反应监测的机会。上市后药品的经济学评价方法除了常用的成本效果分析方法以外，还注重于效益风险分析、药品列入报销目录的申请、药品的补偿和预算影响分析等。     

上市后药物经济学评价方法Ⅱ:药物经济学原始研究

当现有经济学证据的系统评价不能充分评价上市后药物的经济学情况时,需要开展原始的经济学评价研究。本文主要介绍了原始经济学评价中研究设计,成本和结果的测量,及敏感性分析的原则。总体而言,四种设计方案可用于经济学评价,不同方案各有其优缺点。结果和成本的测量方法有多种,主要根据研究要求和适用性选择不同的方法。对各种可能影响结果的因素应采用不同的分析方法进行分析。     

中国国家医保谈判药品药物经济学评价研究的系统评价

目的 系统评价中国国家医保谈判药品的药物经济学评价研究。方法 计算机检索PubMed、EMbase、The Cochrane Library、CNKI和WanFang Data数据库,搜集中国国家医保谈判药品的药物经济学评价研究,检索时限为2012年1月1日至2022年1月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,进行定性系统评价。结果 国家医保谈判药品有59种（33.9%）发表过药物经济学评价研究,涉及124篇文献。仅有23种（13.2%）药品在医保谈判前已有药物经济学评价研究发表,共29篇文献（23.3%）。所有已发表研究中,有75篇（60.5%）得出研究药物比对照药物更具经济性优势的阳性结论。结论 目前国家医保谈判药品的药物经济学评价研究仍存在不足,需进一步推动相关研究,为国家医保谈判提供证据支持。     

上市后药物经济学评价方法Ⅲ:影响方法学质量和结果可适用性的因素

方法学质量和结果可适用性是评价已发表药物经济学评价研究可靠性和适用性的重要方面,也是影响我国上市后药物社会经济价值评价的因素。本文探讨了经济学评价研究中影响方法学质量和结果可适用性的因素及其方式,并特别强调了在我国条件下的影响因素。本文讨论了经济学评价合理的设计、实施和分析和报道方法,并介绍了现有评价经济学研究方法学质量量表中,两种适用于我国的评价量表。     

卫生经济学分析的系统评价方法与挑战

卫生经济学分析的系统评价借鉴随机对照试验系统评价的基本原则和方法，整合针对某一疾病的某些干预措施的所有相关经济学研究，系统分析不同经济学分析研究结果的差异，为决策提供经济学综合分析证据。它主要包括以下7个步骤：①形成研究问题；②确定筛选标准；③文献检索与筛选；④文献质量评价；⑤数据获取；⑥数据分析与综合；⑦结果报告。但由于卫生经济学研究的特殊性，其系统评价也面临明显的方法学问题与挑战，诸如经济学分析模型、分析角度、研究时间范围、不确定性处理和敏感度分析方法等差异给证据评价、合成带来了明显的异质性，而且更需要关注合成证据结果的外推性。     

药品标示外使用的循证医学评价方法探讨

目的介绍国内外药品标示外使用的循证医学评价情况,探讨药品标示外使用的循证医学评价方法。方法综合国内外相关文献,从证据来源、证据分级及推荐强度三个方面探讨药品标示外使用的循证医学评价方法。结果药品标示外使用的证据来源包括临床药理学、药品咨询系统(DRUGDEX?System)、肿瘤药典及手工检索补充的证据;证据分级及推荐强度可参考2009年牛津证据分级与推荐意见强度(治疗部分)和药品咨询系统的推荐强度和证据强度。结论本研究初步建立了一种系统的药品标示外使用的循证医学评价方法。     

浅谈药物经济学

药物经济学通过4种评价方法，对药物治疗的成本和药物治疗的结果两方面进行鉴别、测量和比较，确定最佳的治疗方案，以最大限度地合理利用现有的药物资源。药物经济学在指导药品定价。遏制药费增长以及临床药学中发挥积极作用。     

药物经济学及其对临床用药的指导作用

作为卫生经济学的分支之一 ,药物经济学是在80年代发展起来的一门边缘学科 ,在 1 989年产生了第一本专门的英文版学术杂志《药物经济学》。药物经济学的概念引入中国 ,也不过才 1 0年左右的时间 ,而且只是在近二、三年才开展相关研究。本文从药物经济学的概念、研究方法及其对临床用药的指导作用等方面来阐述药物经济学。1　药物经济学概述1 .1　基本概念　作为一门边缘学科 ,药物经济学主要是利用经济学原理和药学知识 ,来研究提高药物资源的技术和配置效率 ,以促进合理用药、控制全社会药品费用的不合理增长 ,同时也为政府制定药品价格、…     

我国示范乡镇卫生院基本药物循证评价与遴选之十一:冠心病

目的基于疾病负担,循证遴选中国乡镇卫生院治疗冠心病的基本药物。方法应用本系列研究之二制定的循证评价与遴选标准、方法和流程,循证评价并推荐治疗冠心病的基本药物。结果①共纳入11个临床指南,含3个循证指南。②各国指南共涉及冠心病治疗药物13类61种。③硝酸甘油、硝酸异山梨酯、美托洛尔、维拉帕米、硝苯地平、依那普利、阿司匹林和肝素均被WHO EML(2011)、NEML(2009)、CNF(2010)推荐,在各指南中证据相对较多,质量较高;普萘洛尔和辛伐他汀均被WHO EML(2011)、NEML(2009)、CNF(2010)推荐但在指南中证据相对较少;氨氯地平、氯吡格雷和链激酶虽未全被3个目录推荐但在指南中证据较多。④上述13个推荐药物国内均有相应剂型和规格上市,药物价格可负担。⑤中文低质量证据表明5个药物(硝酸甘油、硝酸异山梨酯、美托洛尔、阿司匹林和肝素)治疗冠心病有效,未检索到相关药物的中文系统评价和经济学评价证据。结论①冠心病治疗药物强推荐硝酸甘油、硝酸异山梨酯、美托洛尔、维拉帕米、硝苯地平、依那普利、阿司匹林;弱推荐普萘洛尔、氨氯地平、氯吡格雷、肝素、链激酶、辛伐他汀。②国内冠心病药物治疗研究证据质量不高,缺少经济学评价研究。③建议循证制定我国冠心病临床指南,规范全国临床治疗;开展冠心病药物经济学评价研究,进行同类比较成本-效果研究。     

抗菌药物卫生经济学评价及外部性分析的系统评价

目的 对抗菌药物外部性的卫生经济学评价进行系统评价.方法 计算机检索PubMed、EMbase、The Cochrane Library、 CNKI、WanFang Data和VIP数据库,搜集抗菌药物外部性的药物卫生经济学评价,检索时限均为建库至2020年12月31日.由2名研究者独立筛选文献、提取资料并评价纳入研究...     

Economic evaluation and orthopaedic nursing

In this paper the authors make a case for the use of principles and techniques of economic evaluation to aid the planning of orthopaedic nursing services. The reader is introduced to the basic principles of economics and the subtleties of economic evaluation methods. Case studies are used to highlight not only the importance of these principles and methods but also the challenges involved in carrying out economic evaluations in orthopaedic nursing. Given scarcity of public funds and the need for sustainable health care systems, these challenges need to be faced if orthopaedic nursing services are to be planned in a way that is of maximum benefit to the community.     

Economic evaluation in critical care medicine

Scarce resources are a reality in all health care systems. There is a constant challenge to maximize health benefits within the resources available. This is particularly relevant when caring for critically ill patients, given the resource-intensive technologies and medicines used and the highly specialized professionals required. Moreover, given the high acuity of illness, decision makers and health care providers in critical care units must constantly assess the value derived from therapies and resources used. Economic evaluation is the comparative analysis of alternative health care interventions in their relative costs (resource use) and effectiveness (health effects). Economic evaluations have been increasingly published in critical care journals and read by clinicians. This article illustrates how the basic principles of health economics can be applied to health care decision making through the use of economic evaluation. We demonstrate how economic evaluation can link medical outcomes, quality of life, and costs in a common index, even for therapies for different medical conditions and with different health outcomes. This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown.     

Using the Delphi technique in economic evaluation: time to revisit the oracle?

BACKGROUND AND OBJECTIVE: Although the Delphi technique has been commonly used as a data source in medical and health services research, its application in economic evaluation of medicines has been more limited. The aim of this study was to describe the methodology of the Delphi technique, to present a case for using the technique in economic evaluation, and to provide recommendations to improve such use. METHODS: The literature was accessed through MEDLINE focusing on studies discussing the methodology of the Delphi technique and economic evaluations of medicines using the Delphi technique. RESULTS AND DISCUSSION: The Delphi technique can be used to provide estimates of health care resources required and to modify such estimates when making inter-country comparisons. The Delphi technique can also contribute to mapping the treatment process under investigation, to identifying the appropriate comparator to be used, and to ensuring that the economic evaluation estimates cost-effectiveness rather than cost-efficacy. CONCLUSION: Ideally, economic evaluations of medicines should be based on real-patient data. In the absence of such data, evaluations need to incorporate the best evidence available by employing approaches such as the Delphi technique. Evaluations based on this approach should state the limitations, and explore the impact of the associated uncertainty in the results.     

How much is the life of a cancer patient worth? A pharmaco‐economic perspective

What is known and Objective: Countries struggle to accommodate the introduction of new effective cancer medicines, while containing costs. Our objective is to comment on several pharmaco‐economic challenges involved in determining the value of cancer medicines by reviewing cost‐effectiveness thresholds for cancer medicines in several countries and by discussing the cost‐effectiveness of anti‐cancer biotechnology and orphan medicines. Comment: A literature search was carried out of PubMed, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews and EconLit up to August 2009. Health technology assessment agencies in England and Scotland are willing to incur a higher cost per quality‐adjusted life year for cancer medicines than for other medicines. Risk‐sharing arrangements have been implemented to optimize the value of cancer medicines. The cost‐effectiveness of biotechnology medicines in cancer care is challenged by their high price, and depends on the ability to identify the most responsive target population, through use of suitable biomarkers. The evaluation of orphan medicines in cancer care needs to balance the absence of an alternative therapy for a life‐threatening disease against the high cost‐effectiveness ratio, and usually weak clinical data. What is new and Conclusion: Current strategies used to inform decisions on the funding of expensive anti‐cancer medicines are commented on to highlight important issues and problems. Pharmaco‐economic evaluation is an important tool for assessing the value of cancer medicines and to inform evidence‐based decision making in cancer care. Value‐judgments such as preferential consideration of anti‐cancer medicines can then be made explicitly.     

Economic analysis for clinical practice--the case of 31 national consensus guidelines in the Netherlands

RATIONALE, AIMS AND OBJECTIVE: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. METHODS: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. RESULTS: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between Euros 20,000 and Euros 30,000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. CONCLUSIONS: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.     

Culturally protective parenting practices against substance use among adolescents in Mexico

Abuse of over-the-counter (OTC) medicines is an under-researched and neglected area within the field of substance abuse. The aim of this paper is to raise awareness of the issues surrounding this subject. The paucity of research makes it difficult to comment conclusively on the problem, but studies based on pharmacist perceptions indicate that middle-aged females are particularly affected by OTC medication abuse. The most problematic of the OTC medicines is currently perceived to be Nytolr`, the brand name for the sedative antihistamine diphenhydramine, and which is marketed as a sleep aid. Diphenhydramine is used as a case study to illustrate the type of drugs available OTC and the potentially harmful problems that can arise as a consequence of their unregulated use and supply.     

我国示范乡镇卫生院基本药物循证评价与遴选之十八:腰椎间盘突出症

目的基于疾病负担循证遴选我国示范乡镇卫生院治疗腰椎间盘突出症的基本药物。方法应用本系列研究之二制定的循证评价与遴选标准、方法和流程,循证评价并推荐乡镇卫生院治疗腰椎间盘突出症的基本药物。结果①共纳入6个临床指南,含5个循证指南。②各国指南共涉及腰椎间盘突出症治疗药物4类35种。③对乙酰氨基酚和布洛芬均被WHO EML(2011)、NEML(2009)、CNF(2010)推荐,指南证据相对较多,质量较高;阿司匹林、吲哚美辛和地西泮均被3个目录推荐,证据数量相对较少,质量相对较低。④5个推荐药物国内均有相应剂型和规格上市,药物价格可负担(每日费用0.31～3.38元)。⑤国内低质量研究表明,布洛芬和阿司匹林对症治疗腰椎间盘突出有效(有效率63%～84.5%),但效果均低于各试验药物(有效率88.60%～95.2%)。未检索到其他药物疗效和经济学评价的中文研究证据。结论①腰椎间盘突出症药物以对症治疗为主。②药物推荐:强推荐对乙酰氨基酚和布洛芬,弱推荐阿司匹林、吲哚美辛和地西泮。③国内腰椎间盘突出药物治疗相关研究证据较少,缺高质量指南。④建议循证制定我国腰椎间盘突出症的临床指南,指导临床治疗;基于当前国内外证据基础,在实践中证实药物疗效。