Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, Canada.
Health Technology Assessment Unit, Community Health Sciences and O'Brien Institute of Public Health, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
Pharmacoeconomics. 2018 Apr;36(4):435-449. doi: 10.1007/s40273-018-0609-6.
Chronic constipation (CC) has a significant impact on patients' quality of life and imposes an economic burden on individuals and the healthcare system. Treatment options include dietary changes, lifestyle modifications, fibre supplements, stool softeners, and laxatives.
We undertook this systematic review to comprehensively evaluate the cost effectiveness of treatments for CC.
We searched ten common databases to identify economic evaluations published to 13 June 2017. Abstract and full-text review were completed in duplicate. The quality of the included studies was assessed using the Consensus on Health Economic Criteria. Data extracted included costs and outcomes of treatments for CC and cost-effectiveness methods. A narrative synthesis was completed.
From the 4338 unique citations identified, 79 proceeded to full-text review, with 10 studies forming the final dataset. Eight different definitions of CC were used to define the study populations. Study designs used were decision-tree models (4), Markov model (1), and retrospective (1) and prospective (4) studies. Quality-adjusted life-years (QALY) were reported in five studies; other outcomes included, discontinuation of laxative treatment and frequency of bowel movements. The majority of studies stated that their results were from a payer perspective; however, some of these studies only considered treatment costs, a subset of costs included in the payer perspective. Lifestyle advice, dietary treatments and abdominal massage were each compared with current care with laxatives, while polyethylene glycol (PEG) and senna-fibre combination were each compared with lactulose. Two studies compared newer treatments in patients who had not responded to laxatives: prucalopride was compared with continuing laxatives, and linaclotide was compared with lubiprostone. All of the interventions were reported by the study authors to be cost effective, with the exception of abdominal massage.
A consistent definition of CC is needed and the QALY should be used to capture the diverse symptoms of CC. Further analysis is needed comparing all available treatments for patients who have not responded to laxatives. Overall, results from economic evaluations appear to align with stepwise practice guidelines.
慢性便秘（CC）对患者的生活质量有重大影响，给个人和医疗保健系统带来经济负担。治疗选择包括饮食改变、生活方式调整、纤维补充剂、大便软化剂和泻药。
我们进行了这项系统评价，以全面评估 CC 的治疗成本效益。
我们搜索了十个常见的数据库，以确定截至 2017 年 6 月 13 日发表的经济评估。对摘要和全文进行了重复审查。使用共识健康经济标准评估纳入研究的质量。提取的数据包括 CC 治疗的成本和结果以及成本效益方法。完成了叙述性综合。
从 4338 个独特的引用中，有 79 个进入了全文审查，其中 10 项研究构成了最终数据集。8 种不同的 CC 定义用于定义研究人群。使用的研究设计包括决策树模型（4）、马尔可夫模型（1）以及回顾性（1）和前瞻性（4）研究。五项研究报告了质量调整生命年（QALY）；其他结果包括停止泻药治疗和排便频率。大多数研究表明他们的结果来自支付者的角度；然而，其中一些研究只考虑了治疗成本，这只是支付者角度考虑的成本的一部分。生活方式建议、饮食治疗和腹部按摩分别与当前使用泻药的治疗方法进行了比较，而聚乙二醇（PEG）和番泻叶纤维组合则分别与乳果糖进行了比较。两项研究比较了对泻药无反应的患者的新治疗方法：普芦卡必利与继续使用泻药相比，利那洛肽与鲁比前列酮相比。除了腹部按摩外，所有干预措施都被研究作者报告为具有成本效益。
需要对 CC 进行一致的定义，并且应该使用 QALY 来捕捉 CC 的多种症状。需要进一步分析比较所有可供未对泻药有反应的患者使用的治疗方法。总体而言，经济评估的结果似乎与逐步实践指南一致。
