Parackal Anna, Ramamoorthi Karishini, Tarride Jean-Eric
Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
McMaster Chair, Health Technology Management, McMaster University, Hamilton, Ontario, Canada.
Am J Hosp Palliat Care. 2022 Jan;39(1):108-122. doi: 10.1177/10499091211011138. Epub 2021 May 24.
End-of-life care is a driver of increasing healthcare costs; however, palliative care interventions may significantly reduce these costs. Economic evaluations that measure the incremental cost per quality adjusted life years (QALY) are warranted to inform cost-effectiveness of the intervention relative to a comparator and permit evaluation of investment against other therapeutic interventions. Evidence from the literature up to 2011 indicates a scarcity of cost-utility studies in palliative care research.
This literature review evaluates economic studies published between 2011 and 2019 to determine whether the methods of economic evaluations have evolved since 2011.
A literature search was completed using CENTRAL, OVID MEDLINE, EMBASE and other sources for publications between 2011 and 2019. Study characteristics, methodology and key findings of publications that met the inclusion criteria were reviewed. Quality of studies were assessed using indicators developed by authors of the previous literature review.
46 papers were included for qualitative synthesis. Among them only 6 studies conducted formal cost-effectiveness evaluations-of these 5 measured QALYs and 1 employed probabilistic analyses. In addition, with the exception of 1 costing analysis, all other economic evaluations undertook a healthcare payer perspective. Quality of evidence were comparable to the previous literature review published in 2011.
Despite the small increase in the number of cost-utility studies, the methods of palliative care economic evaluations have not evolved significantly since 2011. More probabilistic cost-utility analyses of palliative care interventions from a societal perspective are necessary to truly evaluate the value for money.
临终关怀是推动医疗保健成本不断上升的一个因素；然而，姑息治疗干预措施可能会显著降低这些成本。进行衡量每质量调整生命年（QALY）增量成本的经济评估，对于了解该干预措施相对于对照措施的成本效益，并允许评估与其他治疗性干预措施相比的投资情况是必要的。截至2011年的文献证据表明，姑息治疗研究中成本效用研究较少。
本综述评估2011年至2019年发表的经济研究，以确定自2011年以来经济评估方法是否有所发展。
使用Cochrane系统评价数据库（CENTRAL）、OVID医学数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）和其他来源完成了对2011年至2019年出版物的文献检索。对符合纳入标准的出版物的研究特征、方法和主要发现进行了综述。使用先前文献综述的作者制定的指标评估研究质量。
纳入46篇论文进行定性综合分析。其中只有6项研究进行了正式的成本效益评估，其中5项衡量了QALY，1项采用了概率分析。此外，除了1项成本分析外，所有其他经济评估均采用医疗保健支付方的视角。证据质量与2011年发表的先前文献综述相当。
尽管成本效用研究的数量略有增加，但自2011年以来，姑息治疗经济评估方法并未显著发展。从社会角度对姑息治疗干预措施进行更多的概率成本效用分析，对于真正评估性价比是必要的。
