Lyman G H
Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208, USA.
Curr Oncol Rep. 2001 Sep;3(5):396-403. doi: 10.1007/s11912-001-0025-4.
To facilitate the comparison of different treatment strategies, measures have been developed that bring together clinical, quality-of-life, and economic outcomes into summary measures such as the quality-adjusted life year, cost-effectiveness, and cost-utility ratios. A number of different types of economic evaluations have been developed, including cost-minimization, cost-effectiveness, and cost-utility analyses. Performance of economic analyses in association with randomized, controlled trials (RCT) has gained increasing enthusiasm in recent years. However, economic measures in RCTs are often outcomes of secondary interest and associated with frequent missing data and inadequate sample size. Variability in the cost measures used and the lack of agreement on clinically meaningful cost differences further limit the conclusions derived from such studies. Economic analyses should be limited to large trials with important trade-offs between efficacy and cost. The strengths and limitations of such analyses are discussed, and guidelines are offered for proper economic analyses in randomized, controlled trials.
为便于比较不同的治疗策略，已制定了一些措施，将临床、生活质量和经济结果汇总为诸如质量调整生命年、成本效益和成本效用比等综合指标。已开展了多种不同类型的经济评估，包括成本最小化、成本效益和成本效用分析。近年来，将经济分析与随机对照试验（RCT）相结合的做法越来越受到青睐。然而，随机对照试验中的经济指标往往是次要关注结果，且常常存在数据缺失和样本量不足的问题。所用成本指标的变异性以及在具有临床意义的成本差异方面缺乏共识，进一步限制了此类研究得出的结论。经济分析应限于在疗效和成本之间存在重要权衡的大型试验。本文讨论了此类分析的优势和局限性，并为随机对照试验中的适当经济分析提供了指导原则。
