中国治疗慢性乙型肝炎的成本-效果的系统评价

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1、中国治疗慢性乙型肝炎的成本-效果的系统评价中国循证医学杂志20o5年第5卷第1l期Cost-effectivenessofTreatmentofChronicHepatitisBinChinaASystematicReviewSUNXin,YANGHuan,WANGLi,Ewa0rlewska.,LIY0u-pingJ.ChineseEvidence—BasedMedicineCenter,WestChinaHospital,SichuanUniversity,Chengdu610041,China;2.CenterforDrugEvalua

2、tion,StateFoodandDrugAdministration,China;3.CenterforPharmacoeconomics,Warsaw,Poland833?【Abstract】ObjectiveTocriticallyappraiseandsystematicallyreviewetheeconomicevaluationsofallaltemativeinterventionsforhepatitisBinChina.MethodsWesearchedMEDLINEandthefourlargestChineseelec

3、tronicdatabas-as.Thereferencesofeligiblestudieswerealsoscreened.Economicevaluationsofanytype,whichstudiedinterventionsforhepatitisB,wereeligibleforinclusion.A25-itemqualitychecklistmodifiedfromaBMJchecklistwasusedtoappraisethequalityofstudies.Theoverallquafityscorewascalcul

4、atedagainst100pointstoindicatetheriskofbias.Qualityappraisalanddataextractionwereconductedbytwoindependentreviewers.ResultsNineteenfulleconomicevaluationsandtwocoststudieswereincludedofwhichfourteenstudieswerescored25—44points,andsevenscored45—61points.Moststudiesadequately

5、documentedeffectivenessofinterventions.However,thecostsofinterventionswerenotwellreportedinover50%ofstudies.Manystudiesinadequatelyconducteddataanalysis,parncularinsensitivityanalysisanddiscounting.Tenstudiescomparedlamivudinewithinterferonorconventionaltherapyfor1-year(or6

6、-month)effects,whichindicatedthatlamivudinewasgenerallycost-effective.Threeevaluationsstudied30-yearoutcomesofinterferoncomparedwithcon-ventionaltherapy,whichsuggestedthatinterferonusuallysavedadditionalcostsandyearsoflife.Anotherthreestudiescom-paredinterferonwithlessfrequ

7、endyusedantiviralagents.howeverthecomparativecost-eWectivenessvaried.TwocostStud-iesshowedthetotalcostsandthepercentageofmedicalcostsincreasedrapidlyinproportiontodiseaseseverity.ConclusionsOfalternativeinterventions,lamivudineiscosteffectiveforshort—termeffects.Interferoni

8、ssuperiortoconventionalther-apyforlong-termoutcomes.However,thelong-termeconomicou