关节内透明质酸与改善病情药物治疗膝骨关节炎的成本效果分析。
Cost Effectiveness of Intra-Articular Hyaluronic Acid and Disease-Modifying Drugs in Knee Osteoarthritis.
机构信息
Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, 51092, France.
Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, 51095, France.
出版信息
Pharmacoeconomics. 2018 Nov;36(11):1321-1331. doi: 10.1007/s40273-018-0695-5.
BACKGROUND
The place of disease-modifying osteoarthritis drugs (DMOADs) and intra-articular hyaluronic acid (IAHA) in the therapeutic arsenal for knee osteoarthritis (OA) remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification.
OBJECTIVE
This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA.
METHODS
A systematic literature search of the MEDLINE, Scopus, EMBASE and Cochrane databases was performed independently by two rheumatologists who used the same predefined eligibility criteria to identify relevant articles. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualised and converted to 2015 euros (€) using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average.
RESULTS
A total of 95 abstracts were selected, and 13 articles were considered for the review: nine articles on IAHA and four on DMOADs. Only one article directly compared different IAHA compounds. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICERs) ranged from €4000 to €57,550 and from €240 to €53,225 per quality-adjusted life-year (QALY) gained for DMOADs and IAHA, respectively.
CONCLUSIONS
This review highlights substantial heterogeneity between studies, ranging from a cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of €50,000/QALY. Additional research is needed to determine reliable and robust ICER estimates for knee OA therapies.
背景
对于膝骨关节炎（OA）的治疗方案，疾病修饰性骨关节炎药物（DMOAD）和关节内透明质酸（IAHA）的地位仍不确定。实际上，这些治疗方法已显示出对症状的疗效，但对疾病的改善没有效果。
目的
本报告回顾了用于治疗膝 OA 的 IAHA 和 DMOAD 的成本效益。
方法
两名风湿病学家独立进行了系统的文献检索，检索了 MEDLINE、Scopus、EMBASE 和 Cochrane 数据库，使用相同的预设纳入标准来识别相关文章。没有摘要且语言不是英语或法语的文章被排除在外。提取的成本按年度计算，并使用相关国家的消费者价格指数和这些国家与欧盟平均水平之间的 2013 年购买力平价换算为 2015 年欧元（€）。
结果
共选择了 95 篇摘要，有 13 篇文章被认为符合综述要求：9 篇关于 IAHA，4 篇关于 DMOAD。只有一篇文章直接比较了不同的 IAHA 化合物。文章在方法学方法上存在很大的异质性。增量成本效益比（ICER）范围分别为 DMOAD 和 IAHA 的每获得一个质量调整生命年（QALY）的 4000 欧元至 57550 欧元和 240 欧元至 53225 欧元。
结论
本综述强调了研究之间存在很大的异质性，从节省成本（或主导）的立场到非常高的 ICER，远高于 50000 欧元/QALY 的可接受阈值。需要进一步研究来确定膝 OA 治疗的可靠和稳健的 ICER 估计。
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