Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Pharmacoeconomics. 2019 May;37(5):669-688. doi: 10.1007/s40273-018-00761-6.
Neuropathic pain significantly reduces an individual's quality of life and places a significant economic burden on society. As such, many cost-effectiveness analyses (CEAs) have been published for treatments available for neuropathic pain.
The primary objective of this systematic review was to provide a detailed summary of the estimates of cost-effectiveness from published CEAs comparing available treatments for neuropathic pain. The secondary objectives were to identify the key drivers of cost-effectiveness and to assess the quality of published CEAs in neuropathic pain.
We searched Embase, MEDLINE, Cochrane CENTRAL and seven other databases to identify CEAs reporting the costs, health benefits (e.g., quality-adjusted life-years or disability-adjusted life-years) and summary statistics, such as incremental cost-effectiveness ratios, of treatments for neuropathic pain. We excluded studies reporting diseases other than neuropathic pain, those for which the full text was not available (e.g., conference abstracts), studies not written in English or not published in peer-reviewed journals, and narrative reviews, editorials and opinion papers. Titles and abstract reviews, full-text reviews, and data extraction were all performed by two independent reviewers, with disagreement resolved by a third reviewer. Mean costs, health benefits, and summary statistics were reported and qualitatively compared across studies, stratified by time horizon. Drivers of cost-effectiveness were assessed using reported one-way sensitivity analyses. The quality of all included studies was evaluated using the Tufts CEA Registry Quality Score and study reporting using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist.
A total of 22 studies were identified and included in this systematic review. Included studies were heterogeneous in the treatments compared, methodology and design, perspectives, and time horizons considered, making cross-study comparisons difficult. No single treatment was consistently the most cost-effective across all studies, but tricyclic antidepressants were the preferred treatment at a willingness-to-pay threshold of $US50,000 per quality-adjusted life-year in several studies with a short time horizon and a US payer perspective. Among the 14 studies reporting one-way sensitivity analyses, drivers of cost-effectiveness included utility values for health states and the likelihood of pain relief with treatment. The quality of the identified CEAs was moderate to high, and overall reporting largely met CHEERS recommendations.
To assess drivers of cost-effectiveness and quality, we only included studies with the full text available and thus excluded some CEAs that reported cost-effectiveness results. The heterogeneity of the included studies meant that the study results could not be synthesized and comparison across studies was limited.
Though many pulished studies have evaluated the cost-effectiveness of treatments for neuropathic pain, significant heterogeneity between CEAs prevented synthesis of the results. Standardized methodology and improved reporting would allow for more reliable comparisons across studies.
神经病理性疼痛显著降低了个体的生活质量，并给社会带来了巨大的经济负担。因此，许多针对神经病理性疼痛治疗的成本效益分析（CEA）已经发表。
本系统综述的主要目的是详细总结已发表的 CEA 中针对神经病理性疼痛的可用治疗方法的成本效益估计值。次要目标是确定成本效益的关键驱动因素，并评估神经病理性疼痛中已发表的 CEA 的质量。
我们检索了 Embase、MEDLINE、Cochrane 中央和其他七个数据库，以确定报告成本、健康效益（例如，质量调整生命年或残疾调整生命年）和汇总统计数据（如增量成本效益比）的 CEA，这些 CEA 用于治疗神经病理性疼痛。我们排除了报告除神经病理性疼痛以外疾病的研究、无法获取全文的研究（例如会议摘要）、非英文撰写或未发表在同行评议期刊上的研究，以及叙述性评论、社论和观点论文。标题和摘要审查、全文审查和数据提取均由两名独立审查员进行，意见分歧由第三名审查员解决。报告了平均成本、健康效益和汇总统计数据，并按时间范围对研究进行了定性比较。使用报告的单因素敏感性分析评估了成本效益的驱动因素。使用 Tufts CEA 登记质量评分和 CHEERS（综合健康经济评估报告标准）清单评估所有纳入研究的质量。
共确定了 22 项研究并纳入了本系统综述。纳入的研究在比较的治疗方法、方法和设计、观点以及考虑的时间范围方面存在异质性，使得跨研究比较变得困难。没有一种单一的治疗方法在所有研究中始终是最具成本效益的，但在一些时间范围较短且具有美国支付者视角的研究中，三环类抗抑郁药在愿意支付每质量调整生命年 50000 美元的阈值下成为首选治疗方法。在报告了单因素敏感性分析的 14 项研究中，成本效益的驱动因素包括健康状况的效用值和治疗后疼痛缓解的可能性。确定的 CEA 的质量为中等到较高，总体报告在很大程度上符合 CHEERS 建议。
为了评估成本效益的驱动因素和质量，我们仅纳入了有全文的研究，因此排除了一些报告成本效益结果的 CEA。纳入研究的异质性意味着无法综合研究结果，限制了研究之间的比较。
尽管许多已发表的研究评估了神经病理性疼痛治疗的成本效益，但 CEA 之间的显著异质性使得无法综合研究结果。标准化的方法和改进的报告将允许更可靠地进行研究之间的比较。
