Wisløff Torbjørn, Hagen Gunhild, Hamidi Vida, Movik Espen, Klemp Marianne, Olsen Jan Abel
Norwegian Knowledge Centre for the Health Services, Postboks 7004 St. Olavs plass, 0130, Oslo, Norway,
Pharmacoeconomics. 2014 Apr;32(4):367-75. doi: 10.1007/s40273-014-0136-z.
Reimbursement agencies in several countries now require health outcomes to be measured in terms of quality-adjusted life-years (QALYs), leading to an immense increase in publications reporting QALY gains. However, there is a growing concern that the various 'multi-attribute utility' (MAU) instruments designed to measure the Q in the QALY yield disparate values, implying that results from different instruments are incommensurable. By reviewing cost-utility analyses published in 2010, we aim to contribute to improved knowledge on how QALYs are currently calculated in applied analyses; how transparently QALY measurement is presented; and how large the expected incremental QALY gains are. We searched Embase, MEDLINE and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from health interventions were included. Of the 370 studies included in this review, 48% were pharmacoeconomic evaluations. Active comparators were used in 71% of studies. The median incremental QALY gain was 0.06, which translates to 3 weeks in best imaginable health. The EQ-5D-3L is the dominant instrument used. However, reporting of how QALY gains are estimated is generally inadequate. In 55% of the studies there was no reference to which MAU instrument or direct valuation method QALY data came from. The methods used for estimating expected QALY gains are not transparently reported in published papers. Given the wide variation in utility scores that different methodologies may assign to an identical health state, it is important for journal editors to require a more transparent way of reporting the estimation of incremental QALY gains.
现在，几个国家的报销机构要求根据质量调整生命年（QALY）来衡量健康结果，这导致报告QALY增益的出版物数量大幅增加。然而，人们越来越担心，旨在衡量QALY中“Q”的各种“多属性效用”（MAU）工具产生的价值各不相同，这意味着不同工具的结果不可比。通过回顾2010年发表的成本效用分析，我们旨在增进对以下方面的认识：在应用分析中目前如何计算QALY；QALY测量的呈现方式有多透明；预期的增量QALY增益有多大。我们在Embase、MEDLINE和NHS EED中搜索了2010年发表的所有成本效用分析。纳入了所有估计从健康干预中获得的QALY的分析。在本综述纳入的370项研究中，48%是药物经济学评估。71%的研究使用了活性对照。增量QALY增益的中位数为0.06，这相当于在最佳健康状态下延长3周。EQ-5D-3L是使用的主要工具。然而，关于如何估计QALY增益的报告总体上并不充分。在55%的研究中，没有提及QALY数据来自哪种MAU工具或直接估值方法。已发表论文中用于估计预期QALY增益的方法没有得到透明报告。鉴于不同方法可能赋予相同健康状态的效用分数差异很大，期刊编辑要求以更透明的方式报告增量QALY增益的估计非常重要。
