School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK.
Cost Eff Resour Alloc. 2013 Apr 4;11(1):7. doi: 10.1186/1478-7547-11-7.
To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care.
Systematic review.
EMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC.
Randomised controlled trials (RCTs), cohort, case-control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting.
Two independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs.
Fifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings.
Current evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required.
调查在多学科团队（MDT）会议背景下，对二级保健中的癌症和非癌症团队中的患者进行管理的成本效益。
系统评价。
EMBASE、MEDLINE、NHS EED、CINAHL、EconLit、Cochrane 图书馆和 NHS HMIC。
随机对照试验（RCT）、队列、病例对照、前后对照和横断面研究设计，包括在 MDT 会议背景下，对二级保健中任何疾病的管理决策进行经济评估。
两名独立审查员使用共识健康经济标准（CHEC 清单）提取数据并评估方法学质量。MDT 通过以下两个特征的证据来定义：决策需要至少两个学科；以及定期会议以讨论诊断、治疗和/或患者管理，在物理地点或通过电话会议进行。报告 MDT 会议的管理、准备和参加成本以及随后的直接医疗费用、非医疗费用或间接费用的成本，以及与所研究疾病相关的任何健康结果的研究被纳入并分类为癌症或非癌症 MDT。
确定了 15 项研究（11 项非癌症护理中的 RCT、2 项癌症和非癌症护理中的队列研究以及 2 项癌症和非癌症护理中的前后研究），所有研究均存在高度偏倚风险。12 篇论文报告了会议的频率，从每日到每三个月不等，所有论文都报告了所包括的学科数量（平均 5 个，范围 2 至 9）。所有研究的结果均显示出混合效果；高度异质性阻止了对研究结果的荟萃分析；并且没有一项研究报告 MDT 工作的潜在节省如何抵消管理、准备和参加 MDT 会议的成本。
目前的证据不足以确定 MDT 在二级保健中的工作是否具有成本效益。需要进一步的研究来了解导致癌症和非癌症护理具有成本效益的 MDT 工作的关键方面。
