Dritsaki Melina, Rivero-Arias Oliver, Gray Alastair, Ball Catherine, Nanchahal Jagdeep
Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
BMC Musculoskelet Disord. 2018 Jan 25;19(1):34. doi: 10.1186/s12891-018-1949-2.
Dupuytren's disease (DD) is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand. Various treatments have been recommended for advanced disease or to retard progression of early disease and to prevent deterioration of the finger contracture and quality of life. Recent studies have tried to evaluate the clinical and cost-effectiveness of therapies for DD, but there is currently no systematic assessment and appraisal of the economic evaluations.
A systematic literature review was conducted, following PRISMA guidelines, to identify studies reporting economic evaluations of interventions for managing DD. Databases searched included the Ovid MEDLINE/Embase (without time restriction), National Health Service (NHS) Economic Evaluation Database (all years) and the National Institute for Health Research (NIHR) Journals Library) Health Technology Assessment (HTA). Cost-effectiveness analyses of treating DD were identified and their quality was assessed using the CHEERS assessment tool for quality of reporting and Phillips checklist for model evaluation.
A total of 103 studies were screened, of which 4 met the study inclusion criteria. Two studies were from the US, one from the UK and one from Canada. They all assessed the same interventions for advanced DD, namely collagenase Clostridium histolyticum injection, percutaneous needle fasciotomy and partial fasciectomy. All studies conducting a cost-utility analysis, two implemented a decision analytic model and two a Markov model approach. None of them were based on a single randomised controlled trial, but rather synthesised evidence from various sources. Studies varied in their time horizon, sources of utility estimates and perspective of analysis. The overall quality of study reporting was good based on the CHEERS checklist. The quality of the model reporting in terms of model structure, data synthesis and model consistency varied across the included studies.
Cost-effectiveness analyses for patients with advanced DD are limited and have applied different approaches with respect to modelling. Future studies should improve the way they are conducted and report their findings according to established guidance for conducting economic modelling of health care technologies.
The protocol was registered ( CRD42016032989 ; date 08/01/2016) with the PROSPERO international prospective register of systematic reviews.
杜普伊特伦挛缩症（DD）是一种常见的、进行性的手部掌腱膜和指腱膜纤维增生性疾病。对于晚期疾病或延缓早期疾病进展以及预防手指挛缩和生活质量恶化，已推荐了多种治疗方法。最近的研究试图评估DD治疗的临床效果和成本效益，但目前尚无对经济评估的系统评价和评估。
按照PRISMA指南进行系统的文献综述，以确定报告DD管理干预措施经济评估的研究。检索的数据库包括Ovid MEDLINE/Embase（无时间限制）、英国国家医疗服务体系（NHS）经济评估数据库（历年）和英国国家卫生研究院（NIHR）期刊图书馆）卫生技术评估（HTA）。确定了治疗DD的成本效益分析，并使用CHEERS报告质量评估工具和Phillips模型评估清单对其质量进行了评估。
共筛选了103项研究，其中4项符合研究纳入标准。两项研究来自美国，一项来自英国，一项来自加拿大。它们都评估了晚期DD的相同干预措施，即注射溶组织梭状芽孢杆菌胶原酶、经皮针状筋膜切开术和部分筋膜切除术。所有研究都进行了成本效用分析，两项采用了决策分析模型，两项采用了马尔可夫模型方法。它们均未基于单一随机对照试验，而是综合了来自各种来源的证据。研究在时间范围、效用估计来源和分析角度方面存在差异。根据CHEERS清单，研究报告的总体质量良好。在所纳入的研究中，模型报告在模型结构、数据综合和模型一致性方面的质量各不相同。
晚期DD患者的成本效益分析有限，且在建模方面采用了不同的方法。未来的研究应改进其开展方式，并根据卫生保健技术经济建模的既定指南报告其研究结果。
该方案已在PROSPERO国际系统评价前瞻性注册库注册（CRD42016032989；日期2016年1月8日）。
