艰难梭菌相关性腹泻常见治疗策略经济学研究系统评价

Common Therapeutic Strategies for Clostridium Difficile-Associated Diarrhea:A Systematic Review of Pharmacoeconomic Studies

目的为我国艰难梭菌相关性腹泻(CDAD)的治疗决策提供药物经济学参考,促进临床合理用药。方法采用计算机系统检索PubMed,Embase,The Cochrane Library,以及中国知网、万方、维普数据库中2016年1月至2021年4月关于CDAD常见治疗策略比较的经济学研究文献,采用卫生经济学评价报告标准共识(CHEERS)对符合纳入标准的文献进行质量评价。结果共纳入13项研究,其中美国5项,法国2项,中国、日本、西班牙、德国、加拿大、澳大利亚各1项。常见治疗策略为甲硝唑、万古霉素、非达霉素、粪菌移植,13项经济学研究治疗策略为含万古霉素,对比治疗策略包括非达霉素、粪菌移植、甲硝唑;7项研究的决策模型为Markov模型,6项为决策树模型;采用成本-效果分析11项,成本-效用分析和成本-效益分析各1项;13项研究的CHEERS评分得分率均大于75%,文献质量良好。结论目前,国外对CDAD常见治疗策略的经济学研究较多,且多为高质量研究,而国内相关经济学研究稀缺,应加大此类研究力度,为医保及临床治疗决策提供依据。

Objective To provide a pharmacoeconomic reference for the therapy decision of Clostridium difficile-associated diarrhea(CDAD)in China,and to promote clinical rational use of drugs.Methods The pharmacoeconomic studies on the common therapeutic strategies for CDAD in PubMed,Embase,The Cochrane Library and the CNKI,WanFang and VIP databases from January 2016 to April 2021 were systematically searched,and the quality of studies that met the inclusion criteria were evaluated by the Consolidated Health Economic Evaluation Reporting Standards(CHEERS).Results Thirteen studies were included,including five studies from the United States,two studies from France,and one study from China,Japan,Spain,Germany,Canada and Australia respectively.The common ther-apeutic strategies were metronidazole,vancomycin,fidamycin and fecal microbiota transplantation(FMT).The therapeutic strategy in thir-teen pharmacoeconomic studies included vancomycin,and the comparative therapeutic strategies included fidamycin,FMT and metronida-zole.Markov model was adopted in seven studies,decision tree model was adopted in six studies,cost-effectiveness analysis was adopted in eleven studies,cost-effectiveness analysis was adopted in one study,and cost-benefit analysis was adopted in one study.The CHEERS score rate of thirteen studies was higher than 75%,indicating that the quality of studies was good.Conclusion At present,there are many pharmacoeconomic studies on common therapeutic strategies for CDAD abroad,and most of them are high-quality studies.However,there are few relevant pharmacoeconomic studies in China,which should be carried out to provide a basis for health insurance and clinical therapy decision decision-making.