Heyland D K, Kernerman P, Gafni A, Cook D J
Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.
Crit Care Med. 1996 Sep;24(9):1591-8. doi: 10.1097/00003246-199609000-00025.
To determine the extent to which economic evaluations published in the critical care literature provide information that can help us to improve the efficiency of our unit.
We searched computerized bibliographic databases and manually searched key critical care journals to retrieve all economic evaluations.
We included economic evaluations that dealt with clinical problems relevant to the practice of adult critical care and that compared competing healthcare interventions.
Included articles were further evaluated using criteria for minimal methodologic soundness, adopted from the literature, and criteria that we developed to assess the generalizability of results to our clinical setting.
We screened 4,167 papers manually and > 450 abstracts and titles in our computer search. One hundred fifty-one papers were retrieved for further evaluation; 29 papers met our inclusion criteria. Of these 29 papers, only 14 (48%) adequately described competing healthcare interventions, 17 (59%) provided sufficient evidence of clinical efficacy, six (21%) identified, measured, and valuated costs appropriately, and three (10%) performed a sensitivity analysis. None of the papers met all four of these criteria for a minimum level of methodologic soundness. Four (14%) of 29 studies which adequately dealt with issues of cost and efficacy were evaluated using our generalizability criteria. Different costing methods precluded the application of the results of three of the four studies to our intensive care unit.
In the critical care literature, very little useful economic information exists to help decision-makers maximize efficiency in their own setting.
确定重症监护文献中发表的经济评估在多大程度上提供了有助于我们提高科室效率的信息。
我们检索了计算机化的书目数据库，并手动检索了关键的重症监护期刊，以获取所有经济评估。
我们纳入了涉及与成人重症监护实践相关的临床问题且比较了相互竞争的医疗保健干预措施的经济评估。
使用从文献中采用的最低方法学合理性标准以及我们制定的用于评估结果对我们临床环境的可推广性的标准，对纳入的文章进行进一步评估。
我们手动筛选了4167篇论文，并在计算机检索中筛选了450多篇摘要和标题。检索到151篇论文进行进一步评估；29篇论文符合我们的纳入标准。在这29篇论文中，只有14篇（48%）充分描述了相互竞争的医疗保健干预措施，17篇（59%）提供了足够的临床疗效证据，6篇（21%）恰当地识别、测量并评估了成本，3篇（10%）进行了敏感性分析。没有一篇论文满足这四个最低方法学合理性标准。29项充分处理了成本和疗效问题的研究中有4项（14%）使用我们的可推广性标准进行了评估。不同的成本计算方法使四项研究中的三项结果无法应用于我们的重症监护病房。
在重症监护文献中，几乎没有有用的经济信息来帮助决策者在其自身环境中实现效率最大化。
