吸入制剂治疗慢性阻塞性肺疾病的经济学系统评价

Economic Evaluation of Inhaled Preparations in the Treatment of Chronic Obstructive Pulmonary Disease: a Systematic Review

目的:采用系统评价方法评价吸入制剂治疗慢性阻塞性肺疾病稳定期的经济性。方法:计算机检索PubMed、Cochrane Library、Embase、SinoMed、CNKI、WanFang Data、VIP数据库,搜集相关吸入制剂治疗慢性阻塞性肺疾病的经济学评价研究,检索年限均为建库至2018年12月。由两名评价员独立进行文献筛选、资料提取、方法学质量评价,对疗效、成本及成本效果数据进行综合分析。结果:共纳入9篇文献,大部分研究的方法学质量较高。在降低急性加重发生率及改善肺功能指标上,复方吸入制剂或联合吸入方案基本上优于单药吸入方案,但同时治疗成本增加。吸入沙美特罗(SALM)/氟替卡松(FUT)对比单方SALM,增量成本效果(ICER)为$(美元)13 000～46 300/质量调整生命年(QALY)<3倍人均国内生产总值(GDP),增加的成本在可接受范围内。吸入布地奈德(BUD)/氟莫特罗(FORM)+噻托溴铵(TIO)对比单用TIO治疗12周,ICER为■(欧元)149/避免一次严重急性加重。SALM/FUT+TIO较单用TIO治疗1年,ICER为CAN$(加元)145 756/QALY>$50 000/QALY阈值。结论:国产TIO与进口品种疗效相似,但具价格优势;吸入沙美特罗(SALM)/氟替卡松(FUT)与布地奈德(BUD)/氟莫特罗(FORM)均较口服班布特罗具有较好的经济性。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。多项研究均为国外研究,受不同卫生体系及国情限制,研究方法虽有借鉴价值,但结果外在适用性受限。

Objective:A systematic review method was used to evaluate the economics of inhaled preparations therapy in stable phase of chronic obstructive pulmonary disease.Methods:PubMed,the Cochrane Library,Embase,SinoMed,CNKI,WanFang Data and VIP database were electronically searched to collect economic evaluation of inhaled preparations in the treatment of chronic obstructive pulmonary diseasefrom inception to December 2018.Two reviewers independently screened literatures,extracted data and assessed methodological quality.Finally,we comprehensively analyzed the efficacy,cost and cost-effectiveness data.Results:9 studies were included in our research,and majority of which had high quality in methodology.In reducing the incidence of acute exacerbations and improving FEV1,the inhalation of compound preparation or combined inhalation regimen was substantially better than the monotherapy inhalation regimen,but at the same time,the cost of treatment increases.Inhaling Salmeterol/Fluticasone(SALM/FUT)vs.SALM alone,ICER was$13 000 to 46 300/QALY<3 times per capita GDP,and the added cost was acceptable.Inhalation of Budesonide/Flumotorol(BUD/FORM)+Tiotropium bromide(TIO)compared to TIO alone,for 12 weeks of treatment,ICER was■149 to avoid a severe acute exacerbation.Giving SALM/FUT+TIO for a year compared with TIO alone,ICER was CAN$145 756/QALY>$50 000/QALY threshold.Conclusion:The imitation TIO has similar efficacy to the original research variety,but it has a price advantage.Inhalation of SALM/FUT and BUD/FORM are more economical than oral bambuterol.Due to the small number of included studies and the low quality,the above conclusions need to be verified by more high-quality studies.Many studies are foreign studies.Due to the different health systems and national conditions,although the research methods have reference value,the external applicability of the results is limited.