Methods Used in Economic Evaluations of Chronic Kidney Disease Testing - A Systematic Review.
Methods Used in Economic Evaluations of Chronic Kidney Disease Testing - A Systematic Review.
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DOI：
10.1371/journal.pone.0140063
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
eGFR-C study group
中科院分区：
文献类型：
--
作者：
Sutton AJ;Breheny K;Deeks J;Khunti K;Sharpe C;Ottridge RS;Stevens PE;Cockwell P;Kalra PA;Lamb EJ;eGFR-C study group
慢性肾脏疾病(CKD)在世界各地的普通人群中的患病率很高。CKD的靶向测试和筛查通常是为了帮助确定可能从治疗中受益的个人，以改善或防止他们的疾病进展。这篇系统的综述考察了CKD检测和筛查的经济评估中使用的方法，特别关注是否考虑了检测的准确性，以及分析如何结合了可能对患者重要的问题，例如检测对生活质量的影响和它们所产生的成本。通过搜索电子数据库和手工搜索纳入研究的书目，确定了描述以慢性肾脏病为重点的患者检测干预措施的基于模型的经济评估的文章。最初的电子搜索确定了2671篇论文，其中21篇被纳入最后审查。18项研究集中在蛋白尿，3项评估肾小球滤过率测试，1项包括两项测试。在这种情况下，经济评估往往不考虑测试结果不准确的全部影响，因为很少采用社会观点。假阳性检测对患者的影响，包括再次就诊进行重复检测所产生的成本，以及与阳性检测相关的焦虑，几乎总是被忽视。在一项研究中，在敏感性分析中考察了假阳性测试对患者生活质量的影响，这对从模型中得出的结论有重大影响。未来对肾功能检测的经济评估应从患者的角度检查检测和监测途径，以确保在分析中适当考虑对患者重要的问题，如检测结果不准确的可能性。
The prevalence of chronic kidney disease (CKD) is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression. This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur. Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies. The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model. Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis.