Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo.
Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):619-632. doi: 10.1016/j.jaip.2017.07.028. Epub 2017 Sep 28.
Asthma medication cost-effectiveness analyses (CEAs) lack the qualitative assessment regarding whether they capture the National Institutes for Health (NIH) 2012 recommended outcomes necessary to allow robust cross-study comparisons.
We aimed to assess the current asthma outcomes used in CEAs and recommend a direction for improvement.
We performed a systematic search using electronic databases including PubMed, EMBASE, Tufts CEA registry, Cochrane, and NHSEED from January 2010 through December 2015. Key words included (1) cost-effectiveness, cost-utility, economic evaluation, health economics, or cost-benefit AND (2) asthma. All CEA studies evaluating 1 or more asthma medication were included. Authors assessed each CEA study with respect to asthma-specific NIH outcome recommendations including core (hospitalizations, emergency department visits, outpatient visits, medication, interventions costs), supplemental (visit categories and work/school absence), and emerging (academic/job-related) asthma outcomes. Besides outcomes of each CEA, issues that could prevent robust cross-study comparison were identified and thematically summarized.
A total of 12 pre-NIH and 14 post-NIH recommendation CEAs were included. Eleven (91.7%) and 14 (100%) of the pre-/post-NIH studies included at least 1 core outcome, respectively. Of the 26 total studies, 7 (26.9%) included asthma-specific outpatient visit categories, 6 (23.1%) included asthma school or work absences, 5 (19.2%) included respiratory health care use, and none of the studies included emerging outcomes. Other issues that hamper cross-study comparison include lack of standardized cost data, time frames, quality-of-life measures, and incorporation of adherence.
Although the use of NIH-recommended asthma core outcomes has improved, there is still room for improvement in using supplemental and emerging outcomes. To allow robust cross-study comparisons, future work should focus on further standardizing of data sources and methods.
哮喘药物成本效益分析（CEA）缺乏对其是否能捕捉到美国国立卫生研究院（NIH）2012 年推荐的必要结果的定性评估，这些结果对于进行稳健的跨研究比较是必要的。
我们旨在评估当前 CEA 中使用的哮喘结果，并为改进提供方向。
我们使用电子数据库（包括 PubMed、EMBASE、塔夫茨 CEA 注册处、Cochrane 和 NHSEED）进行了系统搜索，检索时间为 2010 年 1 月至 2015 年 12 月。关键词包括（1）成本效益、成本效用、经济评价、卫生经济学或成本效益和（2）哮喘。所有评估 1 种或多种哮喘药物的 CEA 研究均被纳入。作者根据 NIH 特定的哮喘结果建议评估每个 CEA 研究，包括核心（住院、急诊就诊、门诊就诊、药物、干预成本）、补充（就诊类别和工作/学业缺勤）和新兴（学术/职业相关）哮喘结果。除了每个 CEA 的结果外，还确定了可能阻碍稳健的跨研究比较的问题，并进行了主题总结。
共纳入 12 项 NIH 前和 14 项 NIH 后 CEA。前/NIH 研究分别有 11 项（91.7%）和 14 项（100%）包含至少 1 项核心结果。在这 26 项研究中，有 7 项（26.9%）包括哮喘特定的门诊就诊类别，6 项（23.1%）包括哮喘学业/工作缺勤，5 项（19.2%）包括呼吸道保健使用，没有研究纳入新兴结果。其他阻碍跨研究比较的问题包括缺乏标准化的成本数据、时间框架、生活质量测量和纳入依从性。
尽管 NIH 推荐的哮喘核心结果的使用有所改善，但在使用补充和新兴结果方面仍有改进的空间。为了进行稳健的跨研究比较，未来的工作应侧重于进一步标准化数据来源和方法。
