Layer Ashley, McManus Emma, Levell N J
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
Pharmacoecon Open. 2020 Jun;4(2):211-222. doi: 10.1007/s41669-019-0148-x.
The aim of this review was to identify, and assess the quality of, published model-based economic evaluations relating to treatments for patients with venous leg ulcers to help inform future decision-analytic models in this clinical area.
A systematic literature search was performed on six electronic databases, from database inception until 21 May 2018. Search results were screened against predefined criteria by two independent reviewers. Data was then extracted from the included studies using a standardised form, whilst the decision-analytic model-specific Philips Checklist was used to assess quality and to inform model critique.
A total of 23 models were identified, 12 studies used a Markov modelling approach, five used decision trees and six studies did not detail the model type. Studies were predominantly from the National Health Service (NHS)/payer perspective, with only two taking a societal perspective. Interventions were wide ranging, but dressing technologies (11/23) were most common. The intervention studied was found to be dominant in 22/23 studies. The reporting quality of papers was mostly low, with evidence behind model structures, time horizons and data selection consistently underreported across the included papers.
This review has identified a sizeable literature of model-based economic evaluations, evaluating treatments for venous leg ulcers. However, the methods used to conduct such studies were generally poorly reported. In particular, the reporting of evidence surrounding the model structure, justification of the time horizon used and the rationale for selecting data inputs should be focused on in any future models developed.
本综述旨在识别并评估已发表的、基于模型的与下肢静脉溃疡患者治疗相关的经济学评价，以帮助为该临床领域未来的决策分析模型提供信息。
对六个电子数据库进行系统的文献检索，检索时间从数据库建立至2018年5月21日。两名独立评审员根据预先设定的标准对检索结果进行筛选。然后使用标准化表格从纳入的研究中提取数据，同时使用特定于决策分析模型的飞利浦清单来评估质量并为模型评判提供依据。
共识别出23个模型，12项研究采用马尔可夫建模方法，5项采用决策树，6项研究未详细说明模型类型。研究主要从英国国家医疗服务体系（NHS）/支付方的角度进行，只有两项从社会角度进行。干预措施范围广泛，但敷料技术（11/23）最为常见。在所研究的23项研究中，有22项发现干预措施具有优势。论文的报告质量大多较低，在所纳入的论文中，模型结构、时间范围和数据选择背后的证据一直报告不足。
本综述识别出了大量基于模型的经济学评价文献，这些文献评估了下肢静脉溃疡的治疗方法。然而，进行此类研究所用的方法通常报告不佳。特别是，在未来开发的任何模型中，都应重点关注围绕模型结构的证据报告、所用时间范围的合理性以及选择数据输入的理由。
