万古霉素治疗药物监测经济学评价的系统评价（英文）

Economic Evaluation of Vancomycin Therapeutic Drug Monitoring: A Systematic Review

目的:更新万古霉素治疗药物监测(TDM)经济学研究的系统评价并评价纳入的经济学研究的质量。方法:检索Pub Med,Embase,the Cochrane Controlled Trial Registry,National Health Service Economic Evaluation Database,Cost-Effectiveness Analysis Registry,中国知网(CNKI),万方数据知识服务平台和中国生物医学文献数据库(CBM)等数据库,检索词仅使用"vancomycin",2014年1月初次检索,2015年7月更新结果。纳入对万古霉素TDM成本及经济学效益评价的研究。分析TDM的投资回报(ROI)及原始研究所报告的经济学结局。结果:初筛获得67 724篇文献,其中5篇研究满足入选标准。对于恶性血液病、癌症、合并使用具有肾毒性药物、重症监护的患者,万古霉素TDM具有经济学效益,ROI(范围)分别为5.82,1.25(0.07,1.57),0.34(-0.15,5.66),1.02(-0.10,3.12)。对于肾功能正常且未合并使用其他具有肾毒性药物、肾功能稳定、总体使用万古霉素的患者,万古霉素TDM不具经济学效益,ROI(范围)分别为-1.00,-0.30,-0.55(-0.59,-0.25)。结论:万古霉素TDM是否具有经济学效益取决于患者的肾功能及合并疾病情况。万古霉素相关肾毒性发生风险较高的患者可能从TDM中获益。然而,可获得的证据质量较低,TDM的价值需要设计完好的经济学评价研究进一步验证。

Objective：The most recent systematic review on the cost-effectiveness of vancomycin therapeutic drug monitoring （TDM） was published 10 years ago. This study updates this review and rates the quality of the evidence. Methods： PubMed, Embase, the Cochrane Controlled Trial Registry, National Health Service Economic Evaluation Database, Cost-Effectiveness Analysis Registry, and three Chinese bibliographic databases （CNKI, Wanfang and CBM ） were search.ed in January 2014 for studies that included an economic evaluation of TDM; the searching was updated on July 19, 2015. We included studies examined the cost and economic benefit of TDM. Outcome assessment included return on investment （ROI） for TDM and economic outcomes reported in the studies. Results： After screening 67 724 records, 5 studies fulfilled the inclusion criteria. Vancomycin TDM had economic benefits for hematologic malignancies patients, oncology patients, patients receiving concomitant nephrotoxins and intensive care patients （ ROI in TDM （range） ： 5.82, 1.25 （0.07,1.57）, 0.34 （ - 0.15,5.66 ） and 1, 02 （ - 0.10,3.12 ）, respectively）. For patients with normal renal function and not receiving potentially nephrotoxic medications, patients with stable renal function and patients receiving vancomycin, vancomycin TDM didn＇ t have economic advantages （ ROI ： - 1.00, - 0.30 and - 0.55 （ - 0.59, - 0.25） , respectively）. Conclusion：Whether vancomycin TDM has economic advantages depends on the patients＇ preexisting renal function and their comorbid conditions. Patients with a higher risk of vancomycin-induced nephrotoxicity may benefit from TDM from an economic perspective. However, the available evidence is of low quality. Additional, well-designed economic evaluation studies are needed to further confirm the value of TDM.