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目的本研究旨在对中国现有慢性乙型肝炎干预措施的经济学分析研究进行系统评价。方法计算机检索M ED L INE和中国国内4个最大的电子数据库;同时筛检了纳入研究的参考文献,纳入所有慢性乙型肝炎干预措施的经济学评价研究。使用一个由25项组成的总量表评价纳入文献的质量。质量评价和资料提取由两名评价员独立进行。结果纳入19个完整的经济学评价和成本研究,其中14个研究的总体质量为22~44分,7个研究为45~61分。大多数研究充分描述了干预措施的临床效果,但仅50%的研究充分报道了成本鉴定、测量和赋值三个过程。部分研究的数据分析存在问题,特别是敏感性分析和贴现两个方面。10个研究比较了拉米夫定、干扰素和常规治疗1年(或6个月)的效果,结果显示拉米夫定总体上成本-效果更好。3个研究比较了干扰素和常规治疗的长期效果(30年),干扰素治疗方案相对于常规治疗可节约成本,提高疗效。另3个研究比较了干扰素与其他不常用的抗病毒药物,结果其成本-效果不同。2项成本研究结果显示,随着疾病严重程度加剧,医疗成本占总成本比例和总成本均增加。结论在现有干预措施中,拉米夫定的短期成本-效果相对较好。干扰素的长期成本-效果相对常规治疗更好。但各干预措施的长期成本-效果尚不能根据现有研究得到可靠证实。此外,方法学质量,特别是成本的测算较低影响了研究结果的可靠性,有必要提高原始研究报告的质量。总之,运用现有结果进行决策时需仔细考虑。
Objective This study aimed to systematically evaluate the economic analysis of the existing chronic hepatitis B interventions in China. METHODS: M ED L INE was searched by computer and the four largest electronic databases in China. At the same time, the included references were screened and included in the economic evaluation studies of all chronic hepatitis B interventions. A 25-item master scale was used to evaluate the quality of the included articles. Quality evaluation and data extraction were conducted independently by two reviewers. The results included 19 complete economic evaluation and cost studies, of which 14 studies had an overall quality of 22-44 and 7 studies of 45-61. Most studies have adequately described the clinical effects of interventions, but only 50% of the studies have adequately covered the three processes of cost identification, measurement and assignment. Some of the research data analysis problems, especially the sensitivity analysis and discount two aspects. Ten studies compared the efficacy of lamivudine, interferon and conventional therapy for one year (or six months), showing that lamivudine is generally cost-effective. Three studies compared the long-term effects of interferon and conventional therapy (30 years) with the benefits of an interferon regimen that saved costs and increased efficacy compared to conventional therapy. Another three studies compared interferon with other less commonly used antiviral drugs, resulting in different cost-effectiveness. The two cost studies showed that as the severity of the disease aggravated, the proportion of total costs and the total cost of medical care increased. Conclusions Lamivudine’s short-term cost-effectiveness is relatively good among the available interventions. Long-term cost of interferon - the effect is better than conventional treatment. However, the long-term cost-effectiveness of each intervention can not yet be reliably confirmed on the basis of available research. In addition, the poor quality of methodologies, especially the lower costs, affect the reliability of the findings and improve the quality of the original research reports. In short, careful consideration should be given to the decision making using existing results.