METHODS: Two electronic databases (Ovid Medline, Ovid EMBASE) were searched (inception until 5 September-2021) to identify model-based full economic evaluations of treatments for older women with PBC as part of their base-case target population or age-subgroup analysis. Data sources and methods to estimate four types of input parameters including health-related quality of life (HRQoL); natural history; treatment effect; resource use were extracted and appraised. Quality assessment was completed by reference to the Consolidated Health Economic Evaluation Reporting Standards.
RESULTS: Seven model-based economic evaluations were included (older patients as part of their base-case (n = 3) or subgroup (n = 4) analysis). Data from younger patients (< 70 years) were used frequently to estimate input parameters. Different methods were adopted to adjust these estimates for an older population (HRQoL: disutility multipliers, additive utility decrements; Natural history: calibration of absolute values, one-way sensitivity analyses; Treatment effect: observational data analysis, age-specific behavioural parameters, plausible scenario analyses; Resource use: matched control observational data analysis, age-dependent follow-up costs).
CONCLUSIONS: Improving estimated input parameters for older PBC patients will improve estimates of cost-effectiveness, decision uncertainty, and the value of further research. The methods reported in this review can inform future cost-effectiveness analyses to overcome data challenges for this population. A better understanding of the value of treatments for these patients will improve population health outcomes, clinical decision-making, and resource allocation decisions.
方法:两个电子数据库(OvidMedline,OvidEMBASE)进行了搜索(开始至2021年9月5日),以确定基于模型的PBC老年女性治疗方法的全面经济评估,作为其基本病例目标人群或年龄亚组分析的一部分。评估四种类型的输入参数的数据来源和方法,包括与健康相关的生活质量(HRQoL);自然史;治疗效果;提取并评估了资源使用情况。质量评估是通过参考综合卫生经济评价报告标准完成的。
结果:纳入了7项基于模型的经济学评价(老年患者作为基础病例(n=3)或亚组(n=4)分析的一部分)。来自年轻患者(<70岁)的数据经常被用来估计输入参数。采用不同的方法来调整老年人口的这些估计(HRQoL:无效乘数,添加剂效用递减;自然史:绝对值的校准,单向敏感性分析;治疗效果:观察数据分析,特定年龄的行为参数,合理的情景分析;资源使用:匹配的对照观测数据分析,取决于年龄的后续费用)。
结论:改善老年PBC患者的估计输入参数将改善成本效益的估计,决策不确定性,以及进一步研究的价值。这篇综述中报告的方法可以为未来的成本效益分析提供信息,以克服该人群的数据挑战。更好地了解这些患者的治疗价值将改善人群健康结果,临床决策,和资源分配决策。