Low Xinyi Casuarine, Lee Jun Jie, Xie Yewei, Wong Si Min Jolene, Graves Nicholas
Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Preventive Medicine Residency, National University Health System, Singapore.
Eur J Surg Oncol. 2025 Feb;51(2):109490. doi: 10.1016/j.ejso.2024.109490. Epub 2024 Nov 23.
Palliative surgery reduces debilitating symptoms attributable to cancer, and the intent is to improve health-related quality of life. Malignant bowel obstruction is a common indication. Despite positive clinical outcomes, there is a shortage of economic evaluation evidence to support wider adoption of palliative surgery.
The aim of this review is to summarize the existing economic evaluation literature for palliative gastrointestinal surgery for advanced cancer patients with malignant bowel obstruction.
The Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and systematic literature searches were performed using PubMed, Medline, EMBASE and Cochrane. English-language studies comparing cost outcomes of palliative gastrointestinal surgery for malignant bowel obstruction between January 2000 and April 2024 were considered. The Consolidated Health Economic Evaluation Reporting Standards 2022 were used to assess the quality of reporting, and Risk of Bias in Model-based Economic Evaluations was used to examine potential risk of bias of included studies.
A total of nine papers were included, with five reporting cost outcomes only and four were full economic evaluations. Methods used, and the conditions included were heterogenous. There was a lack of consistency in methods and reporting deficits relative to the CHEERS 2022 guideline. Multiple potential sources of bias were detected.
The quality of economic evaluations is quite poor. Heterogeneity among studies limits the ability to compare and generalise findings. Future research should strive to standardize methodologies, improve reporting practices, and develop more robust, high-quality economic evaluations that can better inform decision-making in palliative gastrointestinal surgery for malignant bowel obstruction.
姑息性手术可减轻癌症所致的使人虚弱的症状，目的是改善与健康相关的生活质量。恶性肠梗阻是常见的适应证。尽管临床结果良好，但缺乏经济评估证据来支持更广泛地采用姑息性手术。
本综述的目的是总结现有关于晚期癌症合并恶性肠梗阻患者姑息性胃肠手术的经济评估文献。
遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、Medline、EMBASE和Cochrane进行系统文献检索。纳入2000年1月至2024年4月间比较恶性肠梗阻姑息性胃肠手术成本结果的英文研究。采用《2022年卫生经济评估报告合并标准》评估报告质量，使用基于模型的经济评估中的偏倚风险来检查纳入研究的潜在偏倚风险。
共纳入9篇论文，其中5篇仅报告成本结果，4篇为完整的经济评估。所使用的方法和纳入的情况存在异质性。相对于《2022年卫生经济评估报告合并标准》指南，方法缺乏一致性且报告存在缺陷。检测到多个潜在的偏倚来源。
经济评估的质量相当差。研究之间的异质性限制了比较和归纳结果的能力。未来的研究应努力使方法标准化，改进报告方法，并开展更有力、高质量的经济评估，以便更好地为恶性肠梗阻姑息性胃肠手术的决策提供依据。
