鼻咽癌治疗卫生经济学评价的系统评价

Health economic evaluation in nasopharyngeal carcinoma:a systematic review

目的系统评价有关鼻咽癌(NPC)治疗的卫生经济学评价研究。方法计算机检索PubMed、Web of Science、EMbase、CNKI、WanFang Data和CBM数据库,搜集NPC治疗的经济学评价研究,检索时限均为建库至2022年12月18日。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20个研究。其中14个涉及不同的用药方案,6个涉及化疗及调强放疗、普通放疗和手术的比较。结果显示对复发性、转移或晚期的鼻咽癌患者来说,相较于多西他赛+顺铂、氟尿嘧啶+顺铂或氟尿嘧啶+顺铂+多西他赛,吉西他滨+顺铂(GP)最具经济性。与GP、卡瑞利珠单抗+GP相比,特瑞普利单抗+GP(TGP)更具经济性。对鼻咽癌早期患者来说,调强放疗与常规放疗和手术相比,可能不具经济性。结论当前证据显示,GP和TGP具有较好的卫生经济性,在医疗决策时应平衡患者利弊,选择更有卫生经济性的治疗方案。

Objective To systematically review the health economic evaluation of nasopharyngeal carcinoma(NPC).Methods The PubMed,Web of Science,EMbase,CNKI,WanFang Data and CBM databases were electronically searched to collect the health economic evaluations on NPC from inception to December 18,2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.A descriptive analysis was performed.Results A total of 20 studies were included,which contained 14 about different drug combinations,6 about chemotherapy and the comparison among intensity modulated radiotherapy,conventional radiotherapy and surgery.The results showed that for patients with recurrent,metastatic,or advanced NPC,compared with docetaxel plus cisplatin,fluorouracil plus cisplatin or docetaxel and cisplatin plus fluorouracil,gemcitabine plus cisplatin(GP)was the most economical,and compared with GP or camrelizumab plus GP,toripalimab plus GP(TGP)was more economical.For early-stage NPC,intensity modulated radiotherapy was not economical compared with conventional radiotherapy and surgery.Conclusion Current evidence shows that GP and TGP are economical and can be popularized clinically.