PDF(Pubmed)
Abstract：
OBJECTIVE: To appraise the sources of evidence and methods to estimate input parameter values in decision-analytic model-based cost-effectiveness analyses of treatments for primary breast cancer (PBC) in older patients (≥ 70 years old).
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.
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.
摘要：
目的：评价基于决策分析模型的老年患者（≥70岁）原发性乳腺癌（PBC）治疗成本效益分析的证据来源和方法。
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。
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。
