Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
PLoS One. 2019 Oct 24;14(10):e0224170. doi: 10.1371/journal.pone.0224170. eCollection 2019.
Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia.
A systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal.
Nineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies.
Economic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems. PROSPERO registration no: CRD42018097174.
社区获得性肺炎（CAP）是全球范围内导致死亡和发病的主要原因。在可用于肺炎管理的新型治疗方法中，有效利用资源对于最佳利用资金至关重要。本研究的目的是系统地综述肺炎管理策略的经济分析。
2018 年 5 月，使用 Academic Search Complete、MEDLINE、EconLit、Global health、MEDLINE complete 和 Embase 数据库，使用特定的主题词或关键词进行了系统检索，不限制出版年份。记录所有搜索结果，并纳入详细审查的任何类型的 CAP 管理经济评估。使用卫生保健经济评估报告标准（CHEERS）清单进行质量评估。
符合纳入标准的研究有 19 项；其中 10 项为试验研究，5 项采用基于模型的技术进行分析，其余研究基于观察性研究、记录回顾或干预前后研究。大多数研究进行成本效果分析（n=15）并比较了不同的抗生素组合。这些研究大多数来自发达国家（n=17），考虑了成年人群体（n=16），并采用了提供者视角（n=14）。9 项研究报告了优势替代方案（成本较低但获益更高）。大多数研究（n=15）进行了敏感性分析。14 项研究被评估为优秀、很好或良好质量，研究质量与出版年份之间没有关系。方法学的差异、所使用的微生物类型、视角、成本和结果衡量标准限制了纳入研究结果的兼容性。
迄今为止，对 CAP 管理干预措施的经济评估支持所研究干预措施的成本效益。然而，证据主要涉及发达国家老年人群中抗生素的选择。建议在发达国家和发展中国家对 CAP 的不同管理策略进行平行的经济评估，以支持在卫生保健系统内进行严格和可靠的比较经济分析。PROSPERO 注册号：CRD42018097174。
