Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
JAMA Dermatol. 2024 Nov 1;160(11):1225-1236. doi: 10.1001/jamadermatol.2024.2863.
Although treatment for chronic urticaria (CU) has improved over the past decades, evidence regarding costs and net benefits associated with these treatment strategies have yet to be comprehensively characterized and synthesized.
To summarize the cost and cost-effectiveness of CU management strategies.
An extensive systematic literature search of 6 databases (MEDLINE, Embase, PubMed Cochrane, Scopus, and CINAHL) and gray literature sources, without language restriction, was conducted and updated to March 23, 2024. Articles that performed cost analysis or full economic evaluation among patients with CU were included. Two reviewers independently extracted data, such as annual costs of health care services or incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). All monetary values were converted and inflated to 2023 US dollars. Evidence-based synthesis for health benefit was judged using the Evidence Rating Matrix by the Institute for Clinical and Economic Review.
Seventeen unique studies (11 cost analysis studies and 6 full economic evaluations) were included. With the wide variation in health care resources, services that included biologic omalizumab utilization had higher annual health care cost estimations for CU management than services that did not include omalizumab prescription (median [IQR] cost, $6933 [$5988-$8717] vs $5621 [$2488-$8754]). The biologic omalizumab, 300 mg, for H1 antihistamine-refractory chronic spontaneous urticaria (CSU) (3 studies) was found to have a median (IQR) ICER of $89 005 ($36 058-$145 694) per QALY (evidence rating as incremental or better; moderate certainty with substantial net health benefit). Routine laboratory testing among patients with CSU with otherwise normal histories and physical examination findings (1 study) had ICERs ranging from $1 427 928 to $1 950 524 per QALY (evidence rating as comparable or inferior; moderate certainty that the net health benefit is inferior).
With limited evidence of cost-effectiveness, biologic omalizumab, 300 mg, for H1 antihistamine-refractory CSU was found to be cost-effective in US health care services at the willingness to pay threshold of $150 000 per QALY. Meanwhile, routine laboratory testing among patients with CSU without compelling indication was not cost-effective. Future studies in more diverse CU populations and resource settings are needed to fill evidence gaps.
尽管慢性荨麻疹 (CU) 的治疗在过去几十年中有所改善，但与这些治疗策略相关的成本和净效益的证据尚未得到全面描述和综合。
总结 CU 管理策略的成本和成本效益。
对 6 个数据库（MEDLINE、Embase、PubMed Cochrane、Scopus 和 CINAHL）和灰色文献来源进行了广泛的系统文献检索，没有语言限制，并更新至 2024 年 3 月 23 日。纳入了对 CU 患者进行成本分析或全经济评估的文章。两位审查员独立提取数据，例如医疗保健服务的年度成本或每质量调整生命年 (QALY) 的增量成本效益比 (ICER)。所有货币价值均转换为 2023 年美元，并进行了通货膨胀调整。使用临床和经济审查研究所的证据评级矩阵判断健康效益的循证综合。
纳入了 17 项独特的研究（11 项成本分析研究和 6 项全经济评估）。由于医疗保健资源的广泛差异，包括生物奥马珠单抗的使用的 CU 管理的年度医疗保健成本估计高于不包括奥马珠单抗处方的服务（中位数 [IQR] 成本，$6933 [$5988-$8717] vs $5621 [$2488-$8754]）。对于 H1 抗组胺药难治性慢性自发性荨麻疹 (CSU) 的生物奥马珠单抗 300mg（3 项研究），发现每 QALY 的中位（IQR）ICER 为$89005 ($36058-$145694)（证据评级为增量或更好；具有实质性净健康效益的中等确定性）。对于病史和体格检查正常的 CSU 患者进行常规实验室检查（1 项研究），ICER 范围为每 QALY $1427928 至 $1950524（证据评级为可比或较差；具有净健康效益较差的中等确定性）。
由于成本效益证据有限，生物奥马珠单抗 300mg 用于 H1 抗组胺药难治性 CSU 在符合美国医疗保健服务支付意愿阈值（每 QALY 150000 美元）的情况下具有成本效益。同时，对于没有明确适应证的 CSU 患者进行常规实验室检查不具有成本效益。需要在更多不同 CU 人群和资源环境中开展进一步研究，以填补证据空白。
