Faes Kristof, De Frène Veerle, Cohen Joachim, Annemans Lieven
Department of Public Health, Ghent University, Ghent, Belgium.
Department of Public Health, Ghent University, Ghent, Belgium.
J Pain Symptom Manage. 2016 Oct;52(4):588-599. doi: 10.1016/j.jpainsymman.2016.04.007. Epub 2016 Jul 9.
Patients with chronic obstructive pulmonary disease (COPD) in their final months of life potentially place a high burden on health care systems. Concrete knowledge about resources used and costs incurred by those patients at the end of life is crucial for policymakers.
The aim of this systematic review was to describe the resources used and costs incurred by patients with COPD at the end of life.
We performed a comprehensive literature search in MEDLINE, Web of Science, and EconLit. We screened 886 abstracts and subsequently reviewed 80 full-text articles. Inclusion criteria were at least one type of resource use and/or cost outcome reported in adults diagnosed with COPD during an end-of-life period. Subsequently, we performed quality appraisal consistent with the ISPOR checklist for retrospective database studies and accomplished comprehensive data extraction.
Ten articles fulfilled the inclusion criteria. Three, five, and two studies described European, North American, and Asian health care settings, respectively. All studies had a retrospective design and were published between 2006 and 2015. We observed a very variable resource use, an increased number of hospitalizations, intensive care unit stays, primary care consultations and medication prescriptions, as well as a lack of utilization of formal palliative care services in end-of-life COPD patients. Specific cost items were not well described.
The high use of health care resources in COPD patients in the final months of life suggests a focus on prolonging life and a tendency toward aggressive care. Limiting potentially inappropriate care and improving the quality of end-of-life care in advanced COPD are, therefore, important public health challenges.
慢性阻塞性肺疾病（COPD）患者在生命的最后几个月可能给医疗保健系统带来沉重负担。了解这些患者在生命末期所使用的资源和产生的费用，对于政策制定者而言至关重要。
本系统评价的目的是描述COPD患者在生命末期所使用的资源和产生的费用。
我们在MEDLINE、科学网和EconLit数据库中进行了全面的文献检索。我们筛选了886篇摘要，随后阅读了80篇全文文章。纳入标准为在生命末期被诊断为COPD的成年人中至少报告一种资源使用类型和/或成本结果。随后，我们按照国际药物经济学与结果研究协会（ISPOR）回顾性数据库研究清单进行质量评估，并完成全面的数据提取。
10篇文章符合纳入标准。其中3项、5项和2项研究分别描述了欧洲、北美和亚洲的医疗保健环境。所有研究均采用回顾性设计，发表时间在2006年至2015年之间。我们观察到资源使用差异很大，住院、重症监护病房停留、初级保健咨询和药物处方数量增加，以及生命末期COPD患者未充分利用正规姑息治疗服务。具体成本项目描述不明确。
COPD患者在生命最后几个月对医疗保健资源的高使用表明侧重于延长生命以及积极治疗的倾向。因此，限制潜在的不适当治疗并改善晚期COPD患者的临终护理质量是重要的公共卫生挑战。
