远程医疗中的经济评估可信吗？系统文献回顾。
Can economic evaluation in telemedicine be trusted? A systematic review of the literature.
机构信息
Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, N-9038 Tromsø, Norway.
出版信息
Cost Eff Resour Alloc. 2009 Oct 24;7:18. doi: 10.1186/1478-7547-7-18.
BACKGROUND
Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine.
METHODS
A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured.
RESULTS
This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.
CONCLUSION
As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.
背景
远程医疗被提倡为一种有效的远程提供医疗服务的手段。为了支持该领域的决策，系统的成本和结果信息是必要的。本文回顾了远程医疗中经济评估的质量、有效性和可推广性。
方法
在所有相关数据库中进行了系统的文献检索，并以此为基础来解决这些问题。仅分析了 1990 年至 2007 年期间以英文发表在同行评审期刊上的文章。文献检索确定了 33 项经济评估，这些评估都同时测量了成本（资源利用）和结果（非资源后果）。
结果
本综述表明，远程医疗中的经济评估在研究背景和应用方法方面都具有高度的多样性。这些文章涵盖了从心脏病学、皮肤病学到精神病学等多个医学专业。研究分析了远程医疗在家庭护理、初级和二级保健环境中的应用，使用了各种不同的技术，包括视频会议、静态图像和监测（存储和转发远程医疗）。大多数研究使用了多种结果测量方法，并使用离散的成本-结果框架分析效果。目标、研究设计和比较器的选择大多都有很好的报告。大多数研究缺乏关于观点和成本核算方法的信息，很少使用通用统计和敏感性分析来评估有效性，甚至更少使用边际分析。
结论
正如本文所表明的，所审查的经济评估中，大多数都不符合标准评估技术。需要进一步研究以探讨其原因，并探讨远程医疗中的经济评估如何最好地利用当地的限制，同时产生有效和可推广的结果。
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