长期节律控制药物治疗心房颤动的卫生经济学评价的系统评价  

Health economic evaluations of long-term rhythm-control antiarrhythmic drugs for treating atrial fibrillation:a systematic review

作　　者：李福明 刘世蒙[1,2] 夏宇 肖敦明 陈英耀[1,2] LI Fuming;LIU Shimeng;XIA Yu;XIAO Dunming;CHEN Yingyao(School of Public Health,Fudan University,Shanghai 200032,P.R.China;National Health Commission Key Laboratory of Health Technology Assessment(Fudan University),Shanghai 200032,P.R.China)

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]国家卫生健康委员会卫生技术评估重点实验室(复旦大学),上海200032

出　　处：《中国循证医学杂志》2022年第12期1400-1409,共10页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价长期节律控制药物治疗心房颤动的卫生经济学评价研究现状。方法计算机检索PubMed、EMbase、Scopus、CNKI、SinoMed和WanFang Data数据库及权威卫生技术评估机构官方网站,搜集长期节律控制药物治疗心房颤动的卫生经济学评价研究及基于药物经济性的推荐意见,检索时限均从建库至2022年4月23日。由2名评价员独立筛选文献、提取资料后进行系统评价。结果共纳入19篇文献,包括11个成本-效果/效用分析的研究和8份卫生技术评估机构官方文件。卫生经济学评价研究中仅有5个(45.5%)研究报告质量相对较高,且英文研究质量高于中文研究;纳入研究中缺少卫生经济学分析方案、公平性和分布效应、患者和利益相关者参与及影响等CHEERS 2022的关注要素。评价药物多聚焦于决奈达隆和胺碘酮,且研究结果显示决奈达隆相对于其他药物在不同研究设计和国家环境下均具有成本-效果,然而卫生技术评估机构的推荐意见与研究结果存在差异。结论长期节律控制药物的卫生经济学评价研究报告质量有待改进,需要提高针对中国患者的心房颤动节律控制药物领域的临床证据质量,并通过预算影响分析、分布成本-效果分析等评价方法全面探索药物卫生经济性并为决策者提供高质量决策依据。Objective To systematically review the health economic evaluations of using long-term rhythmcontrol antiarrhythmic drugs(AAD)for patients with paroxysmal or persistent atrial fibrillation(AF).Methods Databases including PubMed,EMbase,Scopus,CNKI,SinoMed,WanFang Data,and official websites of well-established health technology assessment(HTA)institutions were electronically searched to present the economic evaluations of AAD and the recommendations of HTA institutions based on drug economy from inception to April 23rd,2022.Two reviewers independently screened the literature,extracted data and systematic review was then performed.Results A total of 19 studies were included,including 11 cost-effectiveness or cost-utility analysis studies and 8 official documents from HTA institutions.Only 5(45.5%)economic evaluations were of relatively high quality,and English language studies were of higher quality than Chinese language studies ones.The included studies lacked elements that CHEERS 2022 concerns,such as health economics analysis plans,equity and distributional effects,engagement with patients and other stakeholders and the impact on the study.Dronedarone and amiodarone were the main focus of the evaluation,and the study results showed that dronedarone was cost-effective compared with other drugs in different study designs and national settings.However,there were differences between the recommendations of HTA agencies and the results of economic evaluation studies.Conclusion The completeness of health economics evaluations needs to be improved,along with the quality of clinical evidence in the field of AF-AAD for Chinese patients.Additionally,the informational value of drugs should be thoroughly investigated through budget impact analysis and distributional cost-effectiveness analysis to provide evidence of high-quality studies for decision-makers in China.

关 键 词：心房颤动 节律控制 抗心律失常药物 卫生经济学评价 系统评价 

分 类 号：R541.75[医药卫生—心血管疾病] R956[医药卫生—内科学]