Machado Márcio, Iskedjian Michael, Einarson Thomas R
Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile.
Ann Pharmacother. 2006 May;40(5):943-9. doi: 10.1345/aph.1G296. Epub 2006 May 2.
Health economic analyses have become important to healthcare systems worldwide. No studies have previously examined South America's contribution in this area.
To survey the literature with the purpose of reviewing, quantifying, and assessing the quality of published South American health economic analyses.
A search of MEDLINE (1990-December 2004), EMBASE (1990-December 2004), International Pharmaceutical Abstracts (1990-December 2004), Literatura Latino-Americana e do Caribe em Ciências da Saúde (1982-December 2004), and Sistema de Informacion Esencial en Terapéutica y Salud (1980-December 2004) was completed using the key words cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-minimization analysis (CMA), and cost-benefit analysis (CBA); abbreviations CEA, CUA, CMA, and CBA; and all South American country names. Papers were categorized by type and country by 2 independent reviewers. Quality was assessed using a 12 item checklist, characterizing scores as 4 (good), 3 (acceptable), 2 (poor), 1 (unable to judge), and 0 (unacceptable). To be included in our investigation, studies needed to have simultaneously examined costs and outcomes.
We retrieved 25 articles; one duplicate article was rejected, leaving 24 (CEA = 15, CBA = 6, CMA = 3; Brazil = 9, Argentina = 5, Colombia = 3, Chile = 2, Ecuador = 2, 1 each from Peru, Uruguay, Venezuela). Variability between raters was less than 0.5 point on overall scores (OS) and less than 1 point on all individual items. Mean OS was 2.6 (SD 1.0, range 1.4-3.8). CBAs scored highest (OS 2.8, SD 0.8), CEAs next (OS 2.7, SD 0.7), and CMAs lowest (OS 2.0, SD 0.5). When scored by type of question, definition of study aim scored highest (OS 3.0, SD 0.8), while ethical issues scored lowest (OS 1.5, SD 0.9). By country, Peru scored highest (mean OS 3.8) and Uruguay had the lowest scores (mean OS 2.2). A nonsignificant time trend was noted for OS (R2 = 0.12; p = 0.104).
Quality scores of health economic analyses articles published in South America were rated poor to acceptable and lower than previous research from other countries. Thus, efforts are needed to improve the reporting quality of these analyses in South America. Future research should examine the region's level of expertise and educational opportunities for those in the field of health economics.
卫生经济分析对全球医疗体系而言已变得至关重要。此前尚无研究探讨南美洲在该领域的贡献。
对文献进行综述，旨在回顾、量化并评估已发表的南美洲卫生经济分析的质量。
检索MEDLINE（1990年至2004年12月）、EMBASE（1990年至2004年12月）、国际药学文摘（1990年至2004年12月）、拉丁美洲及加勒比地区卫生科学文献数据库（1982年至2004年12月）以及基本治疗与卫生信息系统（1980年至2004年12月），使用关键词成本效益分析（CEA）、成本效用分析（CUA）、成本最小化分析（CMA）和成本效益分析（CBA）；缩写词CEA、CUA、CMA和CBA；以及所有南美洲国家名称。由两名独立评审员按类型和国家对论文进行分类。使用一份包含12项的清单评估质量，将分数评定为4（良好）、3（可接受）、2（差）、1（无法判断）和0（不可接受）。为纳入我们的调查，研究需同时考察成本和结果。
我们检索到25篇文章；一篇重复文章被剔除，剩下24篇（CEA = 15篇，CBA = 6篇，CMA = 3篇；巴西 = 9篇，阿根廷 = 5篇，哥伦比亚 = 3篇，智利 = 2篇，厄瓜多尔 = 2篇，秘鲁、乌拉圭、委内瑞拉各1篇）。评分者之间的总体得分差异小于0.5分，所有单项差异小于1分。平均总体得分是2.6（标准差1.0，范围1.4 - 3.8）。CBA得分最高（总体得分2.8，标准差0.8），CEA其次（总体得分2.7，标准差0.7），CMA得分最低（总体得分2.0，标准差0.5）。按问题类型评分时，研究目的定义得分最高（总体得分3.0，标准差0.8），而伦理问题得分最低（总体得分1.5，标准差0.9）。按国家来看，秘鲁得分最高（平均总体得分3.8），乌拉圭得分最低（平均总体得分2.2）。总体得分呈现不显著的时间趋势（R2 = 0.12；p = 0.104）。
南美洲发表的卫生经济分析文章的质量评分被评定为差至可接受，低于其他国家此前的研究。因此，需要努力提高南美洲这些分析的报告质量。未来的研究应考察该地区卫生经济领域人员的专业水平和教育机会。
