传统改善病情抗风湿药物疗效不佳或不耐受的类风湿关节炎患者药物经济学研究的系统评价

Inadequate efficacy or intolerance with conventional synthetic disease-modifying antirheumatic drug in rheumatoid arthritis patients: a systematic review of pharmacoeconomic evaluation

目的系统评价传统改善病情抗风湿药物(conventional synthetic disease-modifying antirheumatic drugs,csDMARDs)疗效不佳或不耐受的类风湿关节炎患者的药物经济学。方法计算机检索CNKI、WanFang Data、VIP、PubMed、EMbase、Web of Science和The Cochrane Library数据库,搜集有关csDMARDs疗效不佳或不耐受的类风湿关节炎患者的药物经济学研究,检索时限均从建库至2019年3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,进行描述性分析。结果共纳入16个研究。多数研究从付费方的角度用模型法对比了不同治疗模式的经济性。评价的卫生经济学成本主要采用直接成本,且均使用了敏感性分析证明主分析的稳健性。相较于csDMARDs,生物类改善病情抗风湿药物(biological disease-modifying antirheumatic drugs,bDMARDs)可能有更好的经济性;与bDMARDs相比,新上市的靶向改善病情抗风湿药物(targeted synthetic disease-modifying antirheumatic drugs,tsDMARDs)可能有更好的经济性。结论建议可考虑更多地应用新上市的tsDMARDs改善类风湿关节炎患者病情,以促进医疗资源的合理分配。

Objectives To review the pharmacoeconomic evaluation of rheumatoid arthritis patients with an inadequate efficacy or intolerance with conventional synthetic disease modifying antirheumatic drugs(csDMARDs).Methods CNKI, WanFang Data, VIP, PubMed, EMbase, Web of Science and The Cochrane Library were electronically searched to collect pharmacoeconomic studies about rheumatoid arthritis patients with an inadequate efficacy or intolerance with csDMARDs from inception to February 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of the included studies, then, descriptive analysis was performed. Results A total of 16 studies were included, where most compared the economics of different treatment methods from the perspective of the payer by cohort or individual model. The economic costs in the studies were primarily on direct cost. Sensitivity analyses were used to prove the robustness of the main analysis in each study. Biological disease-modifying antirheumatic drugs(bDMARDs) might be more cost-effective than csDMARDs. In addition, compared with the bDMARDs, new-marketed targeted synthetic disease-modifying antirheumatic drugs(tsDMARDs) might be more cost-effective. Conclusions It could be considered to implement more new marketed tsDMARDs to improve patients’ condition to reduce the economic burden and optimize the allocation of health care resources.