哌甲酯治疗儿童注意缺陷多动障碍的经济学系统评价

Pharmacoeconomics of Methylphenidate for Attention Deficit Hyperactivity Disorder in Children: A Systematic Evaluation

目的:评价哌甲酯治疗儿童注意缺陷多动障碍(ADHD)的成本-效果,为国家卫生决策和临床合理用药提供依据。方法:检索PubMed、EMBASE、Cochrane library、CBM、CNKI、VIP等文献数据库,纳入哌甲酯治疗儿童ADHD的各经济学原始研究,按照经济性研究方法学质量评价标准和外在适用性评价标准,对纳入研究严格评价,提取、调整纳入研究的相关数据,进行综合分析。结果与结论:本研究最终纳入5篇文献,大部分方法学质量较高;哌甲酯对比苯丙胺类(右旋苯丙胺、硫酸右旋苯丙胺、苯丙胺/右旋苯丙胺)的成本-效果存在差异;哌甲酯的成本-效果优于苯异妥英低剂量及苯异妥英高剂量,而哌甲酯速释制剂与哌甲酯控释制剂比较无差异。由于国外的经济条件、医疗卫生保健情况的不同,结果不可直接适用于我国国情。鉴于纳入文献较少,本结论仍需高质量的研究证实。

OBJECTIVE： To evaluate the cost - effectiveness of methylphenidate in the treatment of attention deficit hyperactivity disorder （ADHD） for references of healthcare decision- making and clinical rational drug use. METHODS： The original economic studies of methylphenidate for ADHD in children were retrieved from PubMed, EMBASE, Cochrane library, CBM, CNKI, VIP and other bibliographic databases. The quality of the included studies was critically appraised in accordance with the methodological quality evaluation criteria and exterior applicability evaluation criteria of eligible economic studies, and the relative data in the studies were extracted and adjusted for an aggregate analysis. RESULTS ＆ CONCLUSION： Five studies were included in our systematic evaluation, and the majority of which were of high quality in methodology. There were differences between methylphenidate and benzedrinum （DEX, DAS and AMP/DEX） in cost-effectiveness, with MPH showing higher cost - effectiveness as compared with low dose PEM or high dose PEM. However, no difference was noted between MPH-IR and MPH - OROS in cost - effectiveness. However, these results may not be applicable for China since the economy condition and health care condition of the countries stated in China were somewhat different from those of the other countries discussed in the included studies. Furthermore, there were only a few studies were included in our evaluation; therefore, our conclusions remain to be confirmed further by more high quality studies.