Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
Crit Care Med. 2021 Apr 1;49(4):575-588. doi: 10.1097/CCM.0000000000004851.
Cost utility analyses compare the costs and health outcome of interventions, with a denominator of quality-adjusted life year, a generic health utility measure combining both quality and quantity of life. Cost utility analyses are difficult to compare when methods are not standardized. It is unclear how cost utility analyses are measured/reported in critical care and what methodologic challenges cost utility analyses pose in this setting. This may lead to differences precluding cost utility analyses comparisons. Therefore, we performed a systematic review of cost utility analyses conducted in critical care. Our objectives were to understand: 1) methodologic characteristics, 2) how health-related quality-of-life was measured/reported, and 3) what costs were reported/measured.
Systematic review.
We systematically searched for cost utility analyses in critical care in MEDLINE, Embase, American College of Physicians Journal Club, CENTRAL, Evidence-Based Medicine Reviews' selected subset of archived versions of UK National Health Service Economic Evaluation Database, Database of Abstracts of Reviews of Effects, and American Economic Association electronic databases from inception to April 30, 2020.
Adult ICUs.
Adult critically ill patients.
None.
Of 8,926 citations, 80 cost utility analyse studies were eligible. The time horizon most commonly reported was lifetime (59%). For health utility reporting, health-related quality-of-life was infrequently measured (29% reported), with only 5% of studies reporting baseline health-related quality-of-life. Indirect utility measures (generic, preference-based health utility measurement tools) were reported in 85% of studies (majority Euro-quality-of-life-5 Domains, 52%). Methods of estimating health-related quality-of-life were seldom used when the patient was incapacitated: imputation (19%), assigning fixed utilities for incapacitation (19%), and surrogates reporting on behalf of incapacitated patients (5%). For cost utility reporting transparency, separate incremental costs and quality-adjusted life years were both reported in only 76% of studies. Disaggregated quality-adjusted life years (reporting separate health utility and life years) were described in only 34% of studies.
We identified deficiencies which warrant recommendations (standardized measurement/reporting of resource use/unit costs/health-related quality-of-life/methodological preferences) for improved design, conduct, and reporting of future cost utility analyses in critical care.
成本效用分析比较干预措施的成本和健康结果，以质量调整生命年为分母，这是一种综合生命质量和数量的通用健康效用衡量标准。当方法不标准化时，成本效用分析很难进行比较。目前尚不清楚成本效用分析在重症监护中是如何衡量/报告的，以及在这种情况下成本效用分析面临哪些方法学挑战。这可能导致排除成本效用分析比较的差异。因此，我们对重症监护中的成本效用分析进行了系统评价。我们的目的是了解：1）方法学特征，2）健康相关生活质量的测量/报告方式，以及 3）报告/衡量的成本。
系统评价。
我们系统地在 MEDLINE、Embase、美国医师学会杂志俱乐部、CENTRAL、循证医学评论的英国国家卫生服务经济评估数据库存档版本中、数据库的综述文摘和美国经济协会电子数据库中搜索了重症监护中的成本效用分析，检索时间从建库至 2020 年 4 月 30 日。
成人 ICU。
成人危重病患者。
无。
在 8926 条引文，80 项成本效用分析研究符合纳入标准。最常报告的时间范围是终生（59%）。对于健康效用报告，健康相关生活质量很少被测量（29%的报告），只有 5%的研究报告了基线健康相关生活质量。间接效用测量（通用的、基于偏好的健康效用测量工具）在 85%的研究中报告（多数为欧洲生命质量-5 维度，52%）。当患者丧失能力时，很少使用估计健康相关生活质量的方法：推断（19%）、为丧失能力分配固定效用（19%）以及代表丧失能力的患者的代理人报告（5%）。对于成本效用报告的透明度，只有 76%的研究同时报告了单独的增量成本和质量调整生命年。仅在 34%的研究中描述了离散的质量调整生命年（报告单独的健康效用和生命年）。
我们发现了一些缺陷，需要提出建议（标准化测量/报告资源使用/单位成本/健康相关生活质量/方法学偏好），以改进重症监护中未来成本效用分析的设计、实施和报告。
