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基于 EQ-5D 的慢性阻塞性肺疾病成人效用值:系统评价、荟萃分析和荟萃回归。

EQ-5D Based Utility Values for Adults with Chronic Obstructive Pulmonary Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.

机构信息

Health Economics Research Centre, University of Oxford, Oxford, UK.

Science, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, Manchester, UK.

出版信息

COPD. 2024 Dec;21(1):2385358. doi: 10.1080/15412555.2024.2385358. Epub 2024 Jul 31.

Abstract

Chronic obstructive pulmonary disease (COPD) is a common lung disease that negatively affects health-related quality of life (QoL). Utility values, which measure QoL by weighting health states with societal preferences, are required for the cost-utility models that drive economic evaluations and policy decisions. Moayeri et al. published a systematic review and meta-analysis of utilities (EQ-5D) in COPD in June 2016. The current study investigated changes in mean utilities in more recent studies thereafter, exploring heterogeneity in utilities across diverse clinical and study characteristics. Systematic searches of databases, such as MEDLINE and Embase were undertaken from 1 July 2015 until 20 May 2024. A random-effects meta-analysis of utilities (EQ-5D) was performed which addressed inter-study heterogeneity and subgroup analyses. The pooled general mean (95% CI) utility value was 0.761 (0.726-0.795) from 43 studies, whereas Moayeri et al. reported 0.673 (0.653-0.693) from 32 studies. This improvement in mean utilities could be due to increased awareness, early detection, and better medical interventions over the past decade, but demonstrates that a general utility value should be approached with caution given significant heterogeneity. Four meta-regressions were performed on each subgroup: region, method of elicitation, reported comorbidities, and disease stage; of which, method of elicitation, disease stage, and region were found to be significant moderators of utilities. It is, therefore, important to use meta-analysed utilities for cost-utility analyses that reflect the context and patient population of the model. Moreover, these results provide additional evidence for the precision and sensitivity of EQ-5D-5L over EQ-5D-3L.

摘要

慢性阻塞性肺疾病(COPD)是一种常见的肺部疾病,对健康相关生活质量(QoL)有负面影响。效用值通过对健康状况进行社会偏好加权来衡量 QoL,这是驱动经济评估和政策决策的成本效用模型所必需的。Moayeri 等人于 2016 年 6 月发表了一篇关于 COPD 效用值(EQ-5D)的系统评价和荟萃分析。本研究此后调查了更新的研究中平均效用值的变化,探讨了不同临床和研究特征下效用值的异质性。从 2015 年 7 月 1 日至 2024 年 5 月 20 日,对 MEDLINE 和 Embase 等数据库进行了系统检索。采用随机效应荟萃分析(EQ-5D)来解决研究间异质性和亚组分析问题。从 43 项研究中得出了效用(EQ-5D)的综合平均(95%CI)效用值为 0.761(0.726-0.795),而 Moayeri 等人则从 32 项研究中报告了 0.673(0.653-0.693)。过去十年中,由于对疾病的认识提高、早期发现和更好的医疗干预,平均效用值有所提高,但这表明鉴于存在显著的异质性,应谨慎使用一般效用值。对每个亚组进行了四次荟萃回归分析:地区、 elicitation 方法、报告的合并症和疾病阶段;其中 elicitation 方法、疾病阶段和地区被发现是效用的重要调节因素。因此,在进行成本效用分析时,使用反映模型背景和患者人群的荟萃分析效用值非常重要。此外,这些结果为 EQ-5D-5L 比 EQ-5D-3L 的精确性和敏感性提供了额外证据。

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