Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.
Epilepsia. 2019 Dec;60(12):2466-2476. doi: 10.1111/epi.16396. Epub 2019 Nov 30.
Epilepsy is common and carries substantial morbidity, and therefore identifying cost-effective health interventions is essential. Cost-utility analysis is a widely used method for such analyses. For this, health conditions are rated in terms of utilities, which provide a standardized score to reflect quality of life. Utilities are obtained either indirectly using quality of life questionnaires, or directly from patients or the general population. We sought to describe instruments used to estimate utilities in epilepsy populations, and how results differ according to methods used.
We undertook a systematic review of studies comparing at least two instruments for obtaining utilities in epilepsy populations. MEDLINE, Embase, ScienceDirect, Cochrane Library, Google Scholar, and gray literature were searched from inception to June 2019. Mean utilities were recorded and compared for each method.
Of the 38 unique records initially identified, eight studies met inclusion criteria. Utilities were highest for direct "tradeoff" methods, obtained via instruments including standard gamble (0.93) and time tradeoff (0.92), compared to indirect methods, obtained via instruments including EuroQoL five-dimensional form (range = 0.72-0.86) and Health Utilities Index Mark 3 (range = 0.52-0.71). Visual analog scale (VAS), a direct "nontradeoff" instrument, provided equal or lower utilities (range = 68.0-79.8) compared to indirect instruments.
Direct methods, with the important exception of VAS, may provide higher utilities than indirect methods. More studies are needed to identify the most appropriate utility instruments for epilepsy populations, and to investigate whether there is variation between utilities for different types of epilepsy and other patient- and disease-specific factors.
癫痫较为常见且会导致严重的发病率，因此确定具有成本效益的健康干预措施至关重要。成本效用分析是此类分析的常用方法。为此，健康状况根据效用进行评分，效用提供了反映生活质量的标准化评分。效用可以通过使用生活质量问卷间接获得，也可以直接从患者或一般人群中获得。我们旨在描述用于评估癫痫人群中效用的工具，以及根据使用的方法，结果如何有所不同。
我们对比较至少两种用于评估癫痫人群中效用的工具的研究进行了系统评价。从开始到 2019 年 6 月，我们在 MEDLINE、Embase、ScienceDirect、Cochrane 图书馆、Google Scholar 和灰色文献中进行了搜索。记录了每种方法的平均效用，并进行了比较。
最初确定的 38 个独特记录中，有 8 项研究符合纳入标准。直接“权衡”方法（通过标准博弈法[0.93]和时间权衡法[0.92]获得）获得的效用最高，与间接方法（通过包括欧洲五维健康量表在内的工具获得[范围= 0.72-0.86]和健康效用指数标记 3 [范围= 0.52-0.71]）相比。直接“非权衡”工具视觉模拟量表（VAS）提供的效用与间接工具相等或更低（范围= 68.0-79.8）。
除了 VAS 之外，直接方法可能比间接方法提供更高的效用。需要更多的研究来确定最适合癫痫人群的效用工具，并研究不同类型的癫痫和其他患者和疾病特异性因素对效用的差异。
