Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.
World Health Organization Representation to the EU, Brussels, Belgium.
Best Pract Res Clin Rheumatol. 2016 Dec;30(6):981-993. doi: 10.1016/j.berh.2017.09.001. Epub 2017 Oct 5.
Despite the increased interest in economic evaluations, there are difficulties in applying the results of such studies in practice. Therefore, the "Research Agenda for Health Economic Evaluation" (RAHEE) project was initiated, which aimed to improve the use of health economic evidence in practice for the 10 highest burden conditions in the European Union (including low back pain [LBP] and neck pain [NP]). This was done by undertaking literature mapping and convening an Expert Panel meeting, during which the literature mapping results were discussed and evidence gaps and methodological constraints were identified. The current paper is a part of the RAHEE project and aimed to identify economic evidence gaps and methodological constraints in the LBP and NP literature, in particular. The literature mapping revealed that economic evidence was unavailable for various commonly used LBP and NP treatments (e.g., injections, traction, and discography). Even if economic evidence was available, many treatments were only evaluated in a single study or studies for the same intervention were highly heterogeneous in terms of their patient population, control condition, follow-up duration, setting, and/or economic perspective. Up until now, this has prevented economic evaluation results from being statistically pooled in the LBP and NP literature, and strong conclusions about the cost-effectiveness of LBP and NP treatments can therefore not be made. The Expert Panel identified the need for further high-quality economic evaluations, especially on surgery versus conservative care and competing treatment options for chronic LBP. Handling of uncertainty and reporting quality were considered the most important methodological challenges.
尽管人们对经济评估越来越感兴趣，但在实践中应用这些研究结果仍存在困难。因此，启动了“健康经济评估研究议程”（RAHEE）项目，旨在为欧盟 10 种负担最重的疾病（包括下腰痛[LBP]和颈痛[NP]）改善实践中使用健康经济证据的方法。这是通过进行文献制图和召开专家小组会议来实现的，在会议期间讨论了文献制图的结果，并确定了证据差距和方法学限制。本文是 RAHEE 项目的一部分，旨在特别确定 LBP 和 NP 文献中的经济证据差距和方法学限制。文献制图显示，各种常用的 LBP 和 NP 治疗方法（例如注射、牵引和椎间盘造影术）缺乏经济证据。即使有经济证据，许多治疗方法也仅在一项研究中进行了评估，或者针对同一干预措施的研究在患者人群、对照条件、随访时间、设置和/或经济角度方面存在很大的异质性。到目前为止，这使得无法在 LBP 和 NP 文献中对经济评估结果进行统计学汇总，因此无法就 LBP 和 NP 治疗的成本效益得出强有力的结论。专家小组确定需要进一步进行高质量的经济评估，特别是关于手术与保守治疗以及慢性 LBP 的竞争治疗选择。处理不确定性和报告质量被认为是最重要的方法学挑战。
