30 Years of Pharmaceutical Cost-Utility Analyses Growth, Diversity and Methodological Improvement
30 Years of Pharmaceutical Cost-Utility Analyses Growth, Diversity and Methodological Improvement
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DOI：
10.2165/11312720-000000000-00000
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发表时间：
2009-01-01
影响因子：
4.4
通讯作者：
Cohen, Joshua T.
中科院分区：
文献类型：
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作者：
Neumann, Peter J.;Fang, Chi-Hui;Cohen, Joshua T.
目的：回顾和批判性地评价过去30年来发表的与药品有关的成本效用分析（CUAs）。方法：我们检查了来自塔夫茨医学中心成本效益分析登记处（www.cearegistry.org）的数据，其中包含发表在同行评议期刊上的英语CUAs及其比率（以美元计，2008年值）的详细信息。我们对1976年至2006年发表的文章使用描述性统计来总结研究特征。通过趋势检验分析研究方法随时间的变化。对比率的分析仅限于从2000年到2006年发表的那些正确贴现未来成本和收益的研究。与具有有利值（定义为大于所有纳入比率的中位数）相关的因素通过逻辑回归确定。结果：2006年共发表1393份药品审评报告，其中药品审评报告640份，占45.9%。侧重于药品的国别综合评估比例从1990- 2005年期间的34%增加到2001- 2005年期间的47%。美国视角的调查占所有gaas的51%，尽管这一比例随着时间的推移而下降。英国的视角调查占所有研究的近16%，而且这一比例随着时间的推移而增加。大约24%的gaas由行业赞助，48%由非行业来源赞助，28%没有披露其资金来源。对于工业和非工业赞助的研究，坚持良好的方法实践大致相似。随着时间的推移，对这些实践的坚持越来越多。在符合我们纳入标准的1969个比率中，每个QALY的中位数为22,000美元。逻辑回归显示，在控制干预类别（如制药、医疗器械、筛查）的同时，如果来自制药或器械制造商赞助的研究，比率更有可能是有利的（or 1.53; 95% CI 1.07, 2.19）。在控制赞助的情况下，药物CUAs的比率比其他比率更不利（OR 0.66; 95% CI 0.44, 0.98）。结论：已发表的药学论文数量稳步增长，占已发表论文数量的近一半。坚持良好的方法实践似乎并没有因研究发起人而异。来自行业赞助研究的比率比其他比率更有利。结果强调，在药物和非药物干预措施中，有许多有效的医疗保健投资机会，正如有许多低效的投资一样。
Objective: To review and critically evaluate published cost-utility analyses (CUAs) pertaining to pharmaceuticals for the past 3 decades.Methods: We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), which contains detailed information on English-language CUAs and their ratios (in $US, year 2008 values) published in peer-reviewed journals. We summarized study features using descriptive statistics for articles published from 1976 to 2006. Changes in study methodology over time were analysed by trend test. Analysis of ratios was restricted to those published from 2000 to 2006 from studies that correctly discounted future costs and benefits. Factors associated with having a favourable value (defined to be more than the median for all included ratios) were identified by logistic regression.Results: Of 1393 CUAs published through 2006, 640 (45.9%) pertained to pharmaceuticals. The proportion of CUAs that focussed on pharmaceuticals increased from 34% for the period 1990-5 to 47% for the period 2001-5. Investigations with a US perspective accounted for 51% of all CUAs, although this proportion has decreased over time. The UK perspective investigations accounted for nearly 16% of all studies, and this portion has increased over time. About 24% of all CUAs were sponsored by industry, 48% were sponsored by non-industry sources, and 28% did not disclose their funding. Adherence to good methodological practices is roughly similar for studies with industry and non-industry sponsorship. Adherence to these practices has increased over time. Among the 1969 ratios meeting our inclusion criteria, the median value was $US22 000 per QALY.Logistic regression revealed that, while controlling for the intervention category (e.g. pharmaceutical, medical device, screening), ratios were more likely to be favourable if they were from studies sponsored by a pharmaceutical or device manufacturer (OR 1.53; 95% CI 1.07, 2.19). Ratios for pharmaceutical CUAs were less favourable than other ratios while controlling for sponsorship (OR 0.66; 95% CI 0.44, 0.98).Conclusion: The number of published pharmaceutical CUAs has grown steadily and accounts for almost half of all published CUAs. Adherence to good methodological practices does not appear to differ by study sponsor. Ratios from industry-sponsored studies are more favourable than other ratios. The results highlight that there are many opportunities for efficient healthcare investment, among pharmaceutical and non-pharmaceutical interventions, just as there are many investments that are inefficient.