中国肝癌及相关疾病状态健康效用值及失能权重研究的系统评价

Health utility scores and disability weights of liver cancer and related diseases in China:a systematic review

目的系统评价中国人群肝癌及相关疾病研究的健康效用值及失能权重值。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、Wan Fang Data、CBM和VIP数据库,搜集有关中国人群肝癌及相关疾病状态健康效用值及失能权重值的研究,检索时限从建库至2017年11月。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,采用Stata 12.0软件进行Meta分析。结果最终纳入9个研究,涵盖10余种肝癌相关疾病状态,以慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化及肝癌最多见。文献质量整体尚可,最多使用EQ-5D工具测量健康效用值。Meta分析结果显示:慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化和肝癌的合计健康效用值均值及95%CI为0.789(0.735,0.843)、0.734(0.693,0.776)、0.647(0.627,0.666)和0.636(0.508,0.765)。其中应用EQ-5D量表的慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化和肝癌的健康效用值为0.825(0.762,0.868)、0.761(0.731,0.791)、0.643(0.620,0.666)和0.620(0.473,0.766)。此外,描述性分析所得效用值均值中位数(范围)分别为0.758(0.520~0.950)、0.716(0.570~0.900)、0.538(0.260~0.662)和0.541(0.310~0.720)。失能权重研究仅有1个,失能权重值为0.360~0.900。结论中国人群肝癌相关健康效用研究较少,尤其是失能权重研究。Meta分析结果比描述性分析所得健康效用值更高且集中。量表间结果有差异,使用时应注意。此外,健康效用值随疾病加重而降低,提示早预防、早诊治可能挽救生活质量更高的生命年。

Objectives To systematically review the health utility scores and disability weights of liver cancer and related diseases in China. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wan Fang Data,CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata12.0 software. Results A total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was adequate, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789（0.735, 0.843）, 0.734（0.693, 0.776）, 0.647（0.627, 0.666） and 0.636（0.508,0.765）, respectively. Measures from EQ-5D were 0.825（0.762, 0.868）, 0.761（0.731, 0.791）, 0.643（0.620, 0.666） and 0.620（0.473, 0.766）, respectively. In addition, the corresponding median（range） utility scores of the four diseases were found to be 0.758（0.520–0.950）, 0.716（0.570–0.900）, 0.538（0.260–0.662） and 0.541（0.310–0.720）. Only one disability weight study was concluded（0.360–0.900 reported for liver cancer）. Conclusion In Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and centralized than those from descriptive analysis. Different survey tools yield varying outcomes, and attentions should be addressed to their application. The decrease of heath utility scores with the severity of liver disease suggests that early prevention, early diagnosis and treatment can save more years of life with enhanced quality.