成本-效用分析在我国医药卫生领域应用现状的系统综述

Application of Cost-Utility Analysis in Health Area of China:a Systematic Review

目的:评价近年来成本-效用分析(CUA)在我国医药卫生领域的应用现状。方法:检索中国知网、万方、维普3个中文数据库的相关文献,设定"题名"或"关键词"为"成本效用"或"成本-效用";中国知网的学科领域限定为"医药卫生科技",万方限定为"医药卫生",维普限定为"临床医学""中国医学""基础医学""预防医学卫生学"或"药学";发表时间限定为2011年1月-2015年12月。从研究设计、研究角度、成本测算、效用指标及测量方法、CUA的评价指标、贴现和敏感度分析等方面对所纳入的文献进行综合评价。结果:共筛选出符合要求的文献31篇,包含前瞻性研究12篇、回顾性研究9篇、Markov模型研究9篇、混合研究1篇。13篇文献的第一作者单位为医疗机构;7篇文献明确提及了研究角度;绝大多数文献只测算了直接成本(19篇)和以质量调整生命年作为效用指标(27篇);28篇文献描述了具体的效用指标测量方法(直接测量法、间接测量法或文献法)。超过半数的文献(16篇)仅使用成本-效用比(CUR)进行CUA,7篇仅使用增量成本-效用比(ICUR),6篇结合了CUR与ICUR,5篇应用了ICUR的阈值。有11篇文献描述了贴现,且大多为Markov模型研究。有16篇文献进行了敏感度分析,其中11篇仅采用了单因素分析,分析得最多的影响因素是成本,其次是效用值和贴现率。结论:CUA在我国已有较为广泛的应用,但研究的质量和规范性有待改善。应加强借鉴国外的有益经验,提升研究的水平和质量,为临床合理用药、政府决策与医保支付提供真正有价值的参考意见。

OBJECTIVE:To evaluate the application of cost-utility analysis in health area of China in recent year.METHODS:From CNKI,Wanfang and VIP database,setting“cost utility”or“cost-utility”as“title”or“keyword”,related literatures were retrieved during Jan.2011-Dec.2015,with subject field of“medical science and technology”in CNKI,“medical science”inWanfang database,“clinical medicine”“Chinese medicine”“preclinical medicine”“preventive medicine hygiene”or“pharmacy”inVIP.The comprehensive evaluation involved research design,research perspective,cost measurement,utility index and measurementmethod,cost-utility analysis index,discount and sensitivity analysis.RESULTS:A total of31literatures meeting inclusion criteriawere selected,including12prospective studies,9retrospective studies,9Markov model studies,1mixed study.Thirteen literaturesworked in medical institutions.Seven literatures explicitly mentioned research perspective;most literatures only measureddirect cost(19literatures)and adopted QALY as utility index(27literatures).Twenty eight literatures described measurement methodof utility index(direct measurement,indirect measurement or literature method)in detail.More than half(16literatures)analyzedcost-utility by using cost-utility ratio(CUR);7literatures adopted incremental cost-utility ratio(ICUR)and6literatures adopted bothCUR and ICUR.Five literatures used the threshold of ICUR.Eleven literatures described discount,and the majority was Markov modelstudy.Sensitivity analysis was conducted in16literatures,among which11literatures adopted single factor analysis.The most commonlyinvolved influential factor was cost,followed by utility value and discount rate.CONCLUSIONS:Cost-utility analysis has beenwidely used in China,but the quality and normalization of studies have much room for improvement.Learning more experiences frominternational researches can help to promote the quality of domestic studies,guide the practice of clinical rational use of drugs and supportthe government decision-making process and medical insurance payment in the future.