营养用药T3转化-临床研究为基础的成本效果分析

A systematic review of methodology in clinical trial-based health economics study with cost-effectiveness ratio for nutritional drug in T3 transfer of translational medicine

目的对以临床研究为基础的成本-效果有关的营养用药卫生经济学论文的方法学作文献系统分析。方法检索自建库伊始至2019年10月PubMed和万方医学网中营养用药卫生经济学相关文献。按纳入和排除标准筛选文献,并采用Cochrane风险偏倚评估工具和纽卡斯尔-渥太华(Newcastle-Ottawa Scale)量表评价文献质量,并对其方法学(研究对象及分组、混杂因素、研究视角、成本核算、健康产出及卫生经济学分析方法、敏感性分析等)进行系统综述。结果共纳入4篇目标文献。研究对象来源于消化内科、胃肠外科等,并采用随机化分组、回归、倾向性评分匹配等控制混杂因素。从卫生经济学角度分析,文献中研究视角表述有待明晰,主要关注"直接医疗成本",通过计算成本效果比或增量成本效果比来评价医疗干预措施的经济性。结论我国肠外肠内营养学领域高质量的卫生经济学研究证据还需加强,尤其是在混杂因素的控制、研究视角的选择及敏感性分析上,还需多学科的研究团队在实践中去探索。

Objective To systematically review the methodology in clinical trial-based health economics study with cost-effectiveness ratio for nutritional drug.Methods The literature on health economics study for nutritional drug was retrieved from PubMed and Wanfang Medical Network by October 2019.The literature was selected according to inclusion and exclusion criteria,and was assessed using the Cochrane Risk Bias Assessment Tool and Newcastle-Ottawa Scale.Its methodology such as participants and grouping,confounding factors,research perspective,cost accounting,health outcomes and health economics analysis methods,sensitivity analysis,etc,was systematically reviewed as well.Results Four target literatures were included in this study.The participants were from gastroenterology,gastrointestinal surgery,etc.Random grouping,regression,propensity score matching method,etc,were used to control confounding factors.The research perspective needed to be clear according to the principle of health economics study.The present literatures focused on"direct medical costs",and calculated cost-effectiveness ratio or incremental cost-effectiveness ratio to evaluate the economics of medical interventions.Conclusion The evidence of high-quality health economics research in parenteral and enteral nutrition area in China needs to be promoted,especially in the control of confounding factors,the choice of research perspective and sensitivity analysis,which are supposed to be explored by multidisciplinary research teams in practice.