University of Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France.
University of Birmingham, Birmingham, UK.
Pharmacoeconomics. 2020 Apr;38(4):341-356. doi: 10.1007/s40273-019-00874-6.
Demographic and epidemiological changes place an increasing reliance on informal carers. Some support programmes exist, but funding is often limited. There is a need for economic evaluation of interventions for carers to assist policymakers in prioritizing carer support.
Our aim was to systematically review and critically appraise cost-utility analyses of interventions for informal carers, in order to assess the methods employed and the quality of the reporting.
A systematic review of databases was conducted using MEDLINE, Embase, PsycINFO, and EconLit of items published between 1950 and February 2019. Published studies were selected if they involved a cost-utility analysis of an intervention mainly or jointly targeting informal carers. The reporting quality of economic analyses was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.
An initial set of 1364 potentially relevant studies was identified. The titles and the abstracts were then screened, resulting in the identification of 62 full-text articles that warranted further assessment of their eligibility. Of these, 20 economic evaluations of informal carer interventions met the inclusion criteria. The main geographical area was the UK (n = 11). These studies were conducted in mental and/or behavioural (n = 15), cardiovascular (n = 3) or cancer (n = 2) clinical fields. These cost-utility analyses were based on randomized clinical trials (n = 16) and on observational studies (n = 4), of which only one presented a Markov model-based economic evaluation. Four of the six psychological interventions were deemed to be cost effective versus two of the four education/support interventions, and four of the nine training/support interventions. Two articles achieved a CHEERS score of 100% and nine of the economic evaluations achieved a score of 85% in terms of the CHEERS criteria for high-quality economic studies.
Our critical review highlights the lack of cost-utility analyses of interventions to support informal carers. However, it also shows the relative prominence of good reporting practices in these analyses that other studies might be able to build on.
人口和流行病学的变化使得对非正式照顾者的依赖程度不断增加。虽然有一些支持计划，但资金往往有限。需要对照顾者干预措施进行经济评估，以帮助决策者确定照顾者支持的优先顺序。
本研究旨在系统地综述和批判性评价针对非正式照顾者的干预措施的成本效用分析，以评估所采用的方法和报告的质量。
通过 MEDLINE、Embase、PsycINFO 和 EconLit 数据库，检索 1950 年至 2019 年 2 月期间发表的研究，选择主要或联合针对非正式照顾者的干预措施的成本效用分析进行综述。使用统一健康经济评估报告标准（CHEERS）声明评估经济分析的报告质量。
最初确定了 1364 项潜在相关研究。然后筛选标题和摘要，确定了 62 篇符合进一步评估资格的全文文章。其中，20 项针对非正式照顾者干预措施的经济评价符合纳入标准。主要地理区域是英国（n=11）。这些研究分别在精神和/或行为（n=15）、心血管（n=3）或癌症（n=2）临床领域进行。这些成本效用分析基于随机临床试验（n=16）和观察性研究（n=4），其中只有一项是基于马尔可夫模型的经济评估。六项心理干预中有四项被认为比四项教育/支持干预中的两项更具成本效益，九项培训/支持干预中有四项被认为比九项培训/支持干预中的四项更具成本效益。两篇文章在 CHEERS 标准下获得了 100%的分数，九篇经济评价在 CHEERS 标准下获得了 85%的分数，达到了高质量经济研究的标准。
我们的批判性综述强调了缺乏支持非正式照顾者的干预措施的成本效用分析。然而，它也显示了这些分析中相对较好的报告实践，其他研究可能可以在此基础上进行。
