How should cost data in pragmatic randomised trials be analysed?
How should cost data in pragmatic randomised trials be analysed?
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DOI：
10.1136/bmj.320.7243.1197
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发表时间：
2000-04-29
影响因子：
--
通讯作者：
Barber, JA
中科院分区：
文献类型：
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作者：
Thompson, SG;Barber, JA
实用随机试验通常是在现实环境中比较干预措施或医疗政策的大规模多中心研究。其目的是，这些试验的结论，如果被接受，可以直接用于医疗实践。与这些试验一起进行的经济评估越来越普遍，因为评估成本和成本效益以及临床结果通常很重要。成本通常来源于试验中每个患者所使用的医疗资源的数量。使用的每种资源的数量乘以固定的单位成本值，然后将不同类型的资源相加，得出每位患者的总成本。这一信息导致了试验参与者之间一系列不同的成本。作为一个例子，下图显示了月经过多女性随机接受子宫内膜切除术或腹部子宫切除术的费用分布。这种高度倾斜的分布是典型的成本数据；右侧长尾反映了一些患者由于医疗并发症、再手术或延长住院时间等因素而产生高额费用的事实。
Pragmatic randomised trials are usually large scale multicentre studies in which interventions or medical policies are compared in a realistic setting. 1 The intention is that conclusions from these trials, if accepted, can be adopted directly into medical practice. 2 Economic evaluations carried out alongside these trials are increasingly common because it is often important to assess costs and cost effectiveness as well as clinical outcomes. 3 Costs are usually derived from information about the quantity of healthcare resources used by each patient in the trial. The quantities of each resource used are multiplied by fixed unit cost values and are then summed over the separate types of resource to give a total cost per patient. 4 This information leads to a range of different costs across participants in the trial. As an example, the figure shows the distribution of costs in women with menorrhagia randomised to treatment with endometrial resection or abdominal hysterectomy. 5 Such highly skewed distributions are typical of cost data; the long right hand tail reflects the fact that some patients incur high costs because of factors such as medical complications, reoperation, or extended hospital stay.