丙肝治疗药物经济学评价模型的系统评价

Pharmacoeconomic evaluation models for hepatitis C therapies:a systematic review

目的对丙肝治疗药物经济学评价模型进行系统评价,对比不同模型结构、假设、方法学的差异,找出现有建模研究中的不足,从而为构建高质量的丙肝药物经济学评价模型提供建议。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data数据库,搜集关于丙肝治疗药物经济学评价模型的相关文献,检索时限均从2014年8月至2019年8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质量后,对与模型结构、方法和假设有关的数据进行对比和总结。结果最终纳入46个研究,多数研究采用了相似的建模方法,忽略不同的建模要素会造成丙肝治疗价值的高估或低估;所有研究的模型结构和关键参数的来源比较一致;45个研究同时测算了药物治疗成本和健康状态医疗成本;所有研究均报告了以QALYs作为产出指标,并报告了ICER;30个研究同时进行了单因素敏感性分析和概率敏感性分析。结论丙肝治疗药物经济学评价模型研究的总体质量较高,方法学比较统一。但在研究角度、模型类型、模型假设和模型验证等方面仍存在一些差异与不足。建议未来丙肝治疗药物经济性评价模型应同时报告全社会角度的结果、建立动态模型以考虑传播的影响、对长周期进行半循环校正、考虑治愈后复发的情况、对肝移植建模以及进行模型验证等。

Objectives To systematically review the methods of pharmacoeconomic evaluation model for hepatitis C therapies and to identify shortcomings of the existing modeling research by comparing the model structure,hypothesis and methodological differences, and to provide suggestions for the construction of high-quality hepatitis C pharmacoeconomic evaluation models. Methods PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect relevant literatures on the pharmacoeconomic evaluation models for hepatitis C therapies from August 2014 to August 2019. Two reviewers independently screened literature, extracted data,and evaluated the quality of the included studies. Then, the data related to the model structure, methods, and assumptions were compared and summarized. Results Most of the 46 studies that finally included used similar modeling methods.Ignoring different modeling elements would cause overestimation or underestimation of the value of hepatitis C therapies.Model structure of all studies were similar and key parameters were from the same source. Forty-five studies measured the cost of drugs and medical cost of health status. All studies used quality-adjusted life years as the outcome and reported incremental cost-effectiveness ratio. Thirty studies conducted one-way sensitivity analysis and probability sensitivity analysis. Conclusions The included studies share similar methodological designs and have high quality in general.However, there are some differences and deficiencies in research perspective, model types, model assumptions and model verification. Future pharmacoeconomic evaluation model of hepatitis C therapies should report the results of the whole society, establish dynamic model to consider the impact of transmission, make half-cycle correction for long periods,consider the recurrence after cure, model liver transplantation, and verify the model.