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承认经济评估中的患者异质性:系统文献回顾。

Acknowledging patient heterogeneity in economic evaluation : a systematic literature review.

机构信息

Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, The Netherlands.

出版信息

Pharmacoeconomics. 2013 Feb;31(2):111-23. doi: 10.1007/s40273-012-0015-4.

Abstract

BACKGROUND AND OBJECTIVE

Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic evaluations pay only limited attention to patient heterogeneity. The objective of the present paper is to provide a comprehensive overview of the current knowledge regarding patient heterogeneity within economic evaluation of healthcare programmes.

METHODS

A systematic literature review was performed to identify methodological papers on the topic of patient heterogeneity in economic evaluation. Data were obtained using a keyword search of the PubMed database and manual searches. Handbooks were also included. Relevant data were extracted regarding potential sources of patient heterogeneity, in which of the input parameters of an economic evaluation these occur, methods to acknowledge patient heterogeneity and specific concerns associated with this acknowledgement.

RESULTS

A total of 20 articles and five handbooks were included. The relevant sources of patient heterogeneity (demographics, preferences and clinical characteristics) and the input parameters where they occurred (baseline risk, treatment effect, health state utility and resource utilization) were combined in a framework. Methods were derived for the design, analysis and presentation phases of an economic evaluation. Concerns related mainly to the danger of false-positive results and equity issues.

CONCLUSION

By systematically reviewing current knowledge regarding patient heterogeneity within economic evaluations of healthcare programmes, we provide guidance for future economic evaluations. Guidance is provided on which sources of patient heterogeneity to consider, how to acknowledge them in economic evaluation and potential concerns. The improved acknowledgement of patient heterogeneity in future economic evaluations may well improve the efficiency of healthcare.

摘要

背景与目的

患者异质性是可以通过某些患者特征(如年龄、疾病阶段)解释的变异性的一部分。承认患者异质性的人群报销决策可能会节省资金并提高人群健康水平。然而,迄今为止,经济评估仅对患者异质性给予有限关注。本文的目的是全面概述经济评估医疗保健计划中患者异质性的当前知识。

方法

进行了系统的文献综述,以确定经济评估中患者异质性主题的方法学论文。使用 PubMed 数据库的关键字搜索和手动搜索获取数据。还包括手册。提取了与经济评估中患者异质性相关的潜在来源、这些来源出现在经济评估的哪些输入参数中、承认患者异质性的方法以及与这种承认相关的具体问题的相关数据。

结果

共纳入 20 篇文章和 5 本手册。患者异质性的相关来源(人口统计学、偏好和临床特征)以及它们出现的输入参数(基线风险、治疗效果、健康状态效用和资源利用)被组合在一个框架中。得出了经济评估设计、分析和呈现阶段的方法。关注的问题主要与假阳性结果的危险和公平问题有关。

结论

通过系统地审查经济评估医疗保健计划中患者异质性的现有知识,我们为未来的经济评估提供了指导。提供了应考虑哪些患者异质性来源、如何在经济评估中承认它们以及潜在问题的指导。在未来的经济评估中更好地承认患者异质性可能会提高医疗保健的效率。

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