卫生经济学分析的系统评价方法与挑战

Systematic Review of Economic Analyses: Methods and Challenges

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。

Based on the principles and methods of systematic review of randomized controlled clinical trials, systematic review of economic analyses can integrate information from multiple economic studies which focus on the same clinical questions. It can also provide important insights by systematically examining how differences among studies lead to different results. Generally, there are seven steps to conduct such a review： 1） formulating questions; 2） establishing eligibility criteria; 3） searching and selecting eligible economic analyses; 4） assessing the validity of economic analyses; 5） acquiring data; 6） analyzing and synthesizing data; and 7） presenting results. Owing to the specificity of economic analyses, many methodological challenges exist, including the varieties of economic models, analytic perspectives, time horizons, and uncertainty and sensitivity analysis among different economic analyses. This may cause difficulties for critical assessment of the economic analyses.