Huo Zhaohua, Lin Jiaer, Bat Baker K K, Chan Tak Kit, Yip Benjamin H K, Tsoi Kelvin K F
JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
Cost Eff Resour Alloc. 2022 Apr 20;20(1):19. doi: 10.1186/s12962-022-00354-3.
This study aims to synthesize the empirical economic evidence of pharmaceutical therapies for people with dementia.
Systematic review and meta-analysis. Literature evaluating the costs and effects of drug therapies for dementia was indexed until December 2021. Quality of study was assessed using the Cochrane Risk of Bias Tool and Consensus on Health Economic Criteria list. Cost data were standardized to 2020 US dollars and analyzed from healthcare service and societal perspectives. Random-effects models were used to synthesize economic and clinical data, based on mean differences (MDs) and standardized MDs.
Ten unique studies were identified from 11,771 records. Acetylcholinesterase inhibitors (AChEIs) and memantine improved dementia-related symptoms, alongside nonsignificant savings in societal cost (AChEIs: MD-2002 [- 4944 ~ 939]; memantine: MD-6322 [- 14355 ~ 1711]). Despite decreases in cost, antidepressants of mirtazapine and sertraline and second-generation antipsychotics were limited by their significant side effects on patients' cognitive and activity functions. Subgroup analysis indicated that the impacts of AChEIs on cost were affected by different analytical perspectives, follow-up periods, and participant age.
AChEIs and memantine are cost-effective with improvements in dementia-related symptoms and trends of cost-savings. More empirical evidence with non-industrial sponsorships and rigorous design in different settings is warranted.
本研究旨在综合痴呆症患者药物治疗的实证经济证据。
系统评价和荟萃分析。检索截至2021年12月评估痴呆症药物治疗成本和效果的文献。使用Cochrane偏倚风险工具和卫生经济标准共识清单评估研究质量。成本数据标准化为2020年美元，并从医疗服务和社会角度进行分析。基于平均差（MDs）和标准化MDs，使用随机效应模型综合经济和临床数据。
从11771条记录中识别出10项独特的研究。乙酰胆碱酯酶抑制剂（AChEIs）和美金刚改善了痴呆相关症状，同时社会成本节省不显著（AChEIs：MD - 2002[-4944939]；美金刚：MD - 6322[-143551711]）。尽管成本有所降低，但米氮平和舍曲林等抗抑郁药以及第二代抗精神病药因其对患者认知和活动功能有显著副作用而受到限制。亚组分析表明，AChEIs对成本的影响受不同分析角度、随访期和参与者年龄的影响。
AChEIs和美金刚具有成本效益，可改善痴呆相关症状并呈现成本节省趋势。需要更多由非行业赞助且在不同环境下设计严谨的实证证据。
