van Dieten H E, Korthals-de Bos I B, van Tulder M W, Lems W F, Dijkmans B A, Boers M
Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit, Van de Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Ann Rheum Dis. 2000 Oct;59(10):753-9. doi: 10.1136/ard.59.10.753.
A systematic review on the cost effectiveness of prophylactic treatments of non-steroidal anti-inflammatory drug (NSAID) induced gastropathy in patients with osteoarthritis or rheumatoid arthritis was conducted. Two reviewers conducted the literature search and the review. Both full and partial economic evaluations published in English, Dutch, or German were included. The criteria list published in the textbook of Drummond was used to determine the quality of the economic evaluations. The methodological quality of three randomised controlled trials (RCTs) in which the economic evaluations obtained probability estimates of NSAID induced gastropathy and adverse events was assessed by a list of internal validity criteria. The conclusions were based on a rating system consisting of four levels of evidence. Ten economic evaluations were included; three were based on RCTs. All evaluations studied misoprostol as prophylactic treatment: in one evaluation misoprostol was studied as a fixed component in a combination with diclofenac (Arthrotec). All economic evaluations comprised analytical studies containing a decision tree. The three trials were of high methodological quality. Nine economic evaluations were considered high quality and one economic evaluation was considered of low methodological quality. There is strong evidence (level "A") that the use of misoprostol for the prevention of NSAID induced gastropathy is cost effective, and limited evidence (level "C") that the use of Arthrotec is cost effective. Although the levels of evidence used in this review are arbitrary, it is believed that a qualitative analysis is useful: quantitative analyses in this field are hampered by the heterogeneity of economic evaluations. Existing criteria to evaluate the methodological quality of economic evaluations may need refinement for use in systematic reviews.
开展了一项关于非甾体抗炎药（NSAID）诱发的胃病预防性治疗在骨关节炎或类风湿关节炎患者中成本效益的系统评价。两名评价者进行了文献检索和评价。纳入了以英文、荷兰文或德文发表的全面和部分经济评价。使用Drummond教科书中公布的标准清单来确定经济评价的质量。通过一系列内部效度标准评估了三项随机对照试验（RCT）的方法学质量，这三项试验中的经济评价获得了NSAID诱发的胃病和不良事件的概率估计。结论基于一个由四个证据水平组成的评级系统。纳入了十项经济评价；三项基于RCT。所有评价均研究了米索前列醇作为预防性治疗：在一项评价中，米索前列醇被作为与双氯芬酸联合使用的固定成分进行研究（Arthrotec）。所有经济评价均包括含有决策树的分析性研究。这三项试验具有较高的方法学质量。九项经济评价被认为质量高，一项经济评价被认为方法学质量低。有强有力的证据（“A”级）表明，使用米索前列醇预防NSAID诱发的胃病具有成本效益，而使用Arthrotec具有成本效益的证据有限（“C”级）。尽管本评价中使用的证据水平是任意的，但认为定性分析是有用的：该领域的定量分析因经济评价的异质性而受到阻碍。用于评估经济评价方法学质量的现有标准可能需要完善以用于系统评价。
