Abstract：
In 2020, European Network for Health Technology Assessment (EUnetHTA) published a relative effectiveness analysis (REA) of Pretomanid in combination with Bedaquiline and Linezolid for the treatment of extensively drug-resistant (XDR) or treatment-intolerant or nonresponsive multidrug-resistant (MDR) tuberculosis (TB) (REA PTJA14). This REA may have a significant value for low- and middle-income countries (LMICs) outside Europe, particularly those with a high burden of drug-resistant TB. This commentary focuses on whether the REA PTJA14 can be transferred and to what extent a REA can be translated to LMICs context outside Europe. We found that the assessments on the clinical effectiveness and risks of bias reported in REA PTJA14 are useful for LMICs outside Europe. The highly standardized management of TB will support the applicability of the REA to LMICs outside of Europe. Transferring this REA can reduce workload and efficiently use limited resources to conduct health technology assessment (HTA). However, the transfer should consider several critical issues, including variations in health system delivery and clinical practice and setting-specific constraints. In the TB context, the differences in the current standard treatment for XDR or nonresponsive MDR TB, resources availability for drug-resistant TB management, and how healthcare is delivered in the countries can complicate the applicability of the REA PTJA14. Given that LMICs have limitations in doing HTA, it is now critical to develop standard guidelines for transferring REA or other HTA results from high-income countries or other LMICs to maximize the benefits of the REA for LMICs outside Europe.
摘要：
2020年，欧洲卫生技术评估网络（EUnetHTA）发布了Pretomanid与Bedaquiline和Linezolid联合使用的相对有效性分析（REA），用于治疗广泛耐药（XDR）或治疗不耐受或无反应的耐多药（MDR）结核病（TB）（REAPTJA14）。该REA可能对欧洲以外的低收入和中等收入国家（LMICs）具有重要价值。特别是那些耐药结核病负担较高的人群。本评论着重于REAPTJA14是否可以转移，以及REA可以在多大程度上转换为欧洲以外的LMICs上下文。我们发现，在REAPTJA14中报告的对临床有效性和偏倚风险的评估对欧洲以外的LMIC有用。结核病的高度标准化管理将支持REA对欧洲以外的LMIC的适用性。转移此REA可以减少工作量，并有效利用有限的资源进行卫生技术评估（HTA）。然而,转让应该考虑几个关键问题，包括卫生系统交付和临床实践的变化以及特定环境的限制。在TB上下文中，目前XDR或无反应耐多药结核病标准治疗的差异，耐药结核病管理的资源可用性，以及在这些国家如何提供医疗保健可能会使REAPTJA14的适用性复杂化。鉴于LMIC在做HTA方面有局限性，现在，至关重要的是制定标准准则，从高收入国家或其他LMICs转移REA或其他HTA结果，以最大限度地提高REA对欧洲以外的LMICs的好处。
