Javidan Arshia Pedram, Naji Faysal, Li Allen, Wu Annie, Srivatsav Varun, Rapanos Theodore, Harlock John
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
Division of Vascular Surgery, Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Ann Vasc Surg. 2020 Aug;67:511-520.e1. doi: 10.1016/j.avsg.2020.03.033. Epub 2020 Mar 29.
With increasing healthcare costs and the emergence of new technologies in vascular surgery, economic evaluations play a critical role in informing decision-making that optimizes patient outcomes while minimizing per capita costs. The objective of this systematic review is to describe all English published economic evaluations in vascular surgery and to identify any significant gaps in the literature.
We conducted a comprehensive English literature review of EMBASE, MEDLINE, The Cochrane Library, Ovid Health Star, and Business Source Complete from inception until December 1, 2018. Two independent reviewers screened articles for eligibility using predetermined inclusion criteria and subsequently extracted data. Articles were included if they compared 2 or more vascular surgery interventions using either a partial economic evaluation (cost analysis) or full economic evaluation (cost-utility, cost-benefit, and/or cost-effectiveness analysis). Data extracted included publishing journal, date of publication, country of origin of authors, type of economic evaluation, and domain of vascular surgery.
A total of 234 papers were included in the analysis. The majority of the papers included only a cost analysis (183, 78%), and there were only 51 papers that conducted a full economic analysis (22%). The 51 papers conducted a total of 69 economic analyses. This consisted of 32 cost-effectiveness analyses, 29 cost-utility analyses, and 8 cost-benefit analyses. The most common domains studied were aneurysmal disease (89, 38%) and peripheral vascular disease (50, 21%). Economic evaluations were commonly published in the Journal of Vascular Surgery (83, 35%) and Annals of Vascular Surgery (32, 14%), with most study authors located in the United States (127, 54%). There was a trend of economic evaluations being published more frequently in recent years.
The majority of vascular surgery economic evaluations used only a cost analysis, rather than a full economic evaluation, which may not be ideal in pursuing interventions that simultaneously optimize cost and patient outcomes. The literature is lacking in full economic evaluations-a trend persistent in other surgical specialties-and there is a need for full economic evaluations to be conducted in the field of vascular surgery.
随着医疗成本的增加以及血管外科新技术的出现，经济评估在为决策提供信息方面发挥着关键作用，这些决策旨在优化患者治疗效果的同时使人均成本降至最低。本系统评价的目的是描述血管外科领域所有已发表的英文经济评估，并找出文献中存在的显著差距。
我们对EMBASE、MEDLINE、Cochrane图书馆、Ovid Health Star和Business Source Complete进行了全面的英文文献综述，时间跨度从数据库建立至2018年12月1日。两名独立评审员使用预先确定的纳入标准筛选文章以确定其是否符合要求，随后提取数据。如果文章使用部分经济评估（成本分析）或全面经济评估（成本效用、成本效益和/或成本效果分析）比较了两种或更多种血管外科手术干预措施，则将其纳入。提取的数据包括发表期刊、出版日期、作者所在国家、经济评估类型以及血管外科领域。
共有234篇论文纳入分析。大多数论文仅包含成本分析（183篇，占78%），仅有51篇论文进行了全面经济分析（占22%）。这51篇论文共进行了69项经济分析。其中包括32项成本效果分析、29项成本效用分析和8项成本效益分析。研究最多的常见领域是动脉瘤疾病（89项，占38%）和外周血管疾病（50项，占21%）。经济评估常见于《血管外科杂志》（83篇，占35%）和《血管外科学年鉴》（32篇，占14%），大多数研究作者来自美国（127位，占54%）。近年来经济评估有更频繁发表的趋势。
大多数血管外科经济评估仅使用成本分析，而非全面经济评估，这在寻求同时优化成本和患者治疗效果的干预措施时可能并非理想选择。文献中缺乏全面经济评估——这一趋势在其他外科专业中也持续存在——血管外科领域需要进行全面经济评估。
