Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Victoria, Australia.
Dev Med Child Neurol. 2018 Jun;60(6):543-558. doi: 10.1111/dmcn.13653. Epub 2018 Jan 10.
Economic appraisal can help guide policy-making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in cerebral palsy (CP) to inform future research.
Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion.
Of 980 identified references, 115 were included for full-text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost-effective, but stronger evidence for long-term effects is needed. Lifestyle and web-based interventions are inexpensive, but broader measurement of outcomes is required.
Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.
经济评估有助于为卫生干预措施的采购决策、治疗和管理算法提供决策依据。我们对脑瘫（CP）的经济研究进行了系统回顾，以为未来的研究提供信息。
从七个数据库中确定了自 1970 年以来发表的经济研究。两名审查员按照系统评价和荟萃分析的首选报告项目（PRISMA）指南独立筛选摘要并提取数据。任何差异都通过讨论解决。
在 980 篇鉴定的参考文献中，有 115 篇进行了全文评估。13 篇文章符合全经济评估的标准，2 篇为部分经济评估，18 篇为成本研究。6 篇是全经济评估与临床研究或随机对照试验一起进行的，而 7 篇涉及模型模拟。硫酸镁治疗即将早产的经济案例非常有说服力，既实现了健康收益又节省了成本。目前的文献表明鞘内巴氯芬治疗和肉毒毒素注射具有成本效益，但需要更多关于长期效果的证据。生活方式和基于网络的干预措施成本低廉，但需要更广泛的结果衡量。
预防脑瘫会避免重大的经济负担。一些治疗和干预措施已被证明具有成本效益，但需要更多关于临床有效性的证据。本文的贡献：成本效益证据表明预防是最重要的策略。一些治疗方法具有成本效益，但需要更多关于长期效果的证据。由于方法学和不同临床适应症的差异，比较治疗成本具有挑战性。
