麻醉药药物经济学研究方法系统综述和评价方法

Pharmacoeconomic Research and Evaluation Methods of Anesthetics: A Systematic Review

目的 对国内外发表的麻醉药药物经济学评价进行系统综述,归纳其研究方法,总结目前相关研究存在的问题和挑战。方法 检索中国期刊全文数据库、万方数据知识服务平台、PubMed、Embase等数据库,以麻醉、镇静、经济学评价等为关键词,检索时限为建库至2021年11月20日,由两名研究者独立筛选文献、提取资料。结果 共纳入13篇文献,多数评价采用医疗机构角度、基于个体数据开展、并采用成本-效果分析(cost-effectiveness analysis, CEA)。成本指标主要包括药品成本、手术成本、监测成本和管护成本,健康产出指标主要为镇静效果。研究多采用成本-效果比(cost-effectiveness ratio, CER)和增量成本-效果比(incremental cost-effectiveness ratio, ICER)为评价指标,但大部分评价未进行敏感性分析。结论 建议未来进行麻醉药药物经济学评价成本测量时,除药品成本外,将其他麻醉相关成本也纳入考量。由于麻醉患者的意愿支付价格难以获取、质量调整生命年(quality-adjusted life year, QALY)难以测算,因此应用CEA和成本-效用分析(cost-utility analysis, CUA)有一定的挑战,成本-效益分析(cost benefit analysis, CBA)可能是麻醉药领域药物经济学评价目前最适用的研究方法,对应使用麻醉药带来的其他医疗资源的消耗或节约等关键健康产出。

Objective To review systematically the pharmacoeconomic evaluation of anesthetics, summarizing the evaluation methods, major problems and challenges. Methods We searched CNKI, WanFang Data, PubMed and Embase, with keywords such as anaesthesia, sedation, economic evaluation. Two reviewers independently screened literature, extracted data, and included literature on pharmacoeconomic evaluation of anesthetics published before November 20, 2021. Results A total of 13 studies were included, most of which adopted cost-effectiveness analysis(CEA) from the health care provider’s perspective based on individual data. Cost indicators mainly included drug, surgical, monitoring and management costs, and health outcomes were measured using anesthetic effects. Most of the studies reported cost-effectiveness Ratio(CER) and incremental cost-effectiveness ratio(ICER), but few studies conducted sensitivity analysis. Conclusion When measuring costs, future studies are suggested to include other anesthesia-related costs, apart from drug costs. Due to difficulty in obtaining willingness to pay(WTP) and measuring qualityadjusted life year(QALY), applying CEA and cost-utility analysis(CUA) in the pharmacoeconomic evaluations of anesthetics can be challenging, thus, cost-benefit analysis(CBA) may be a rather suitable method. In addition, it is critical to consider wastes or cost-savings of other drugs resulting from the choice of anesthetics in future studies.