非感染性葡萄膜炎药物经济学研究的系统评价

A systematic review of pharmacoeconomic studies of non-infectious uveitis

目的:系统评价非感染性葡萄膜炎(non-infectious uveitis,NIU)的药物经济学研究。方法:计算机检索CNKI,WanFang Data,VIP,PubMed,Cochrane Library,Web of Science和EBSCO数据库以及相关卫生技术评估官网,搜集NIU相关药物经济学研究,检索时限均为建库至2023年4月。由2名研究者独立筛选文献、提取资料并进行质量评价后,对纳入研究进行定性分析。结果:共纳入5项研究,从方法学分析,其中4篇为基于Markov模型的成本-效用分析,但在模型状态设定、模型假设、亚组分析等方面存在差异;临床疗效数据均来源于随机对照试验(randomized controlled trial,RCT);效用数据主要来源于RCT测量结果和视功能调查问卷数据的映射值;成本以直接医疗成本为主。从经济性结果分析,在英国,阿达木单抗注射液与当前的治疗手段(limited current practice,LCP)相比不具有经济性,地塞米松玻璃体内植入剂与LCP相比具有经济性。氟轻松玻璃体内植入剂与LCP相比,在英国情境下认为具有经济性,而在美国则相反。结论:目前新型治疗NIU的药物经济性评价结果因药物类别和国家情境不同而存在差异。建议我国未来开展NIU治疗方案的经济性评价时,关注患者人群异质性、植入剂植入次数、患者缓解和失明等情况,以合理构建评价模型及提出模型假设。同时,缺乏头对头临床试验可采取适当的间接比较方法以减少偏倚,补充社会角度的分析以全面评估药物的社会价值。

Objective:To conduct a systematic review of pharmacoeconomic studies of noninfectious uveitis(NIU).Methods:CNKI,WanFang Data,VIP,PubMed,Cochrane Library,Web of Science,EBSCO databases,and the websites of HTA institutions in various countries were searched to collect pharmacoeconomic studies related to NIU from database inception to April 2023.Two reviewers independently screened the literature,extracted data,and evaluated the quality of the included studies,followed by a qualitative analysis.Results:A total of five studies were included.In terms of methodology analysis,four of them were Markov model-based cost-utility analysis,differing in model state setting,model assumptions,subgroup analysis,and so on.Clinical efficacy data were all from RCTs.The utility data were mainly derived from RCT measurement results and the mapping values of visual function questionnaire data.The costs were mainly direct medical costs.In terms of economic results,adalimumab injection was less cost-effective compared with limited current practice(LCP),while dexamethasone intravitreal implant would be more cost-effective compared with LCP in the UK.Fluocinolone acetonide intravitreal implant was considered to be more cost-effective compared with LCP in the UK context,while the opposite was true in the US.Conclusion:At present,the economic evaluation results of new drugs for NIU treatment vary by drug category and national context.It is recommended that patient heterogeneity,frequency of implantations,patient remission,the occurrence of blindness,and so on should be considered to construct a robust evaluation model and formulate appropriate assumptions in China.Additionally,due to the absence of head-to-head clinical trials,indirect treatment comparison methods should be employed to minimize bias,and social perspective analysis should be supplemented to comprehensively assess the social value of drugs.