中国乳腺癌健康效用值研究的系统评价

Health utility score of breast cancer in China:a systematic review

目的系统评价中国乳腺癌患者的健康效用值,为后续研究提供参考。方法计算机检索Pub Med、EMbase、The Cochrane Library、Web of Science、CNKI、Wan Fang Data、CBM和VIP数据库,搜集我国乳腺癌患者健康效用值的研究,检索时限均为建库至2016年11月。由两位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,采用Stata 12.0软件进行Meta分析。结果最终纳入6个研究。原始横断面研究结果比模型研究结果更集中。Meta分析结果显示,乳腺癌合计健康效用值为[0.77,95%CI(0.67,0.87)],临床0~Ⅰ、Ⅱ、Ⅲ和Ⅳ期健康效用值依次为[0.77,95%CI(0.68,0.86)]、[0.76,95%CI(0.66,0.85)]、[0.74,95%CI(0.65,0.83)]和[0.73,95%CI(0.65,0.81)]。乳腺癌合计效用值中位数(范围)为0.81(0.65,0.83),0、Ⅰ、Ⅱ、Ⅲ和Ⅳ期健康效用值依次为0.82(0.65,1.00)、0.82(0.65,0.90)、0.77(0.67,0.86)、0.70(0.64,0.82)和0.70(0.30,0.80)。结论中国乳腺癌健康效用值研究较少,健康效用值随临床分期加重呈下降趋势,本研究可为后续乳腺癌干预相关成本-效用评价提供参考。

Objective To systematically review the health utility scores for patients with breast cancer in China. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched from inception to November, 2016 to collect studies for health utility scores for breast cancer in China. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using Stata 12.0 software. Results A total of 6 studies were included. Compared with modeling studies, the range of utility scores from cross-sectional studies was narrower. The results of meta-analysis showed the utility scores for breast cancer were 0.77 （95%CI 0.67 to 0.87）, 0.77 （95%CI 0.68 to 0.86） at stage 0 to I, 0.76 （95%CI 0.66 to 0.85） at stage Ⅱ, 0.74 （95%CI 0.65 to 0.83） at stage Ⅲ and 0.73 （95%CI 0.65 to 0.81） at stage IV, respectively. Meanwhile, we descripted the median of utility scores of all studies, and the corresponding values were 0.81 （range 0.65 to 0.83）, 0.82 （range 0.65 to 1.00） at stage 0, 0.82 （range 0.65 to 0.90） at stage Ⅰ, 0.77 （range 0.67 to 0.86） at stage Ⅱ, 0.70 （range 0.64 to 0.82） at stage Ⅲ and 0.70 （range 0.30 to 0.80） at stage Ⅳ, respectively. Conclusion Research on the health utility scores of breast cancer is still limited in China. Utility scores are decreasing among different clinical stages, with lowest score at late stage cancer. These findings can be used in further cost-utility evaluation on various breast cancer interventions.