卫生经济评估(HEE)对政策制定者的影响越来越大,尽管结果在很大程度上取决于所使用方法的质量和透明的报告。这项研究的两个主要目标是评估外束放射治疗(EBRT)的成本分析质量,并评估三个经过验证的质量评估工具中定义的成本标准的全面性和相关性。
文章的选择基于对2004年1月至2015年1月(第1期)MEDLINE中检索的EBRT成本研究的先前系统文献综述,Embase,和NHS-EED数据库,并在2015年1月至2018年11月(第2期)的第二个时间段内完成。三个经过验证的工具,用于评估CHEC和QHES的方法质量,并使用了CHEERS清单的方法。通过定量和定性分析评估质量。使用Kendall一致性系数和类间相关系数检查了评分的稳健性。
总共,选择了23篇文章。成本分析的主要地理区域是加拿大(n=5),法国(n=4),美国(n=4)。最常研究的病理和技术是前列腺(n=7)和头颈癌(n=5)和IMRT(n=8)和IGRT(n=2)。分别。平均仪器得分证明了相当程度的方法学质量,CHEC占69.7%,QHES的73.6%,以及报告质量,第1期的欢呼声为59.4%(74.4%,71.5%,和66.1%,分别,对于周期2)。根据标准进行的额外定性分析显示,某些项目,对于理解成本计算方法和结果至关重要(例如,时间的地平线,贴现率,敏感性分析)通常仅部分完成。统计分析证实,审稿人的评分是一致的。仪器确定了相同的前三篇文章,尽管排名有一定程度的差异。
在EBRT中对成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终HEE结果的影响似乎被低估了,需要提高数据源和方法的透明度。
Health economic evaluations (HEE) are increasingly having an impact on policymakers, although the results greatly depend on the quality of the methodology used and on transparent reporting. The two main objectives of this study were to evaluate the quality of cost analyses of external beam radiotherapy (EBRT) and to assess the comprehensiveness and relevance of cost criteria defined in three validated quality-assessment instruments.
The selection of articles was based on a previous systematic literature
review of EBRT-costing studies retrieved from January 2004 to January 2015 (Period 1) in MEDLINE, Embase, and NHS-EED databases and completed in a second time period from January 2015 to November 2018 (Period 2). Three validated instruments to assess the methodology quality with the CHEC and the QHES, and the methodology with the CHEERS checklists were used. The quality was evaluated by both quantitative and qualitative analyses. The scoring robustness was examined with the Kendall coefficient of concordance and inter-class correlation coefficients.
In total, twenty-three articles were selected. The main geographic areas of cost analyses were Canada (n = 5), France (n = 4), and the USA (n = 4). The most commonly studied pathologies and technologies were prostate (n = 7) and head and neck cancer (n = 5) and IMRT (n = 8) and IGRT (n = 2), respectively. The mean instrument scores demonstrated a fair degree of methodological quality, with 69.7% for the CHEC, 73.6% for the QHES, as well as for the reporting quality, with 59.4% for CHEERS for Period 1 (74.4%, 71.5%, and 66.1%, respectively, for Period 2). An additional qualitative analysis per criterion revealed that certain items, essential for understanding the costing methodology and the results (e.g., the time horizon, discount rate, sensitivity analysis) were often only partially completed. Statistical analysis confirmed that the reviewers\' scoring was consistent. The instruments identified the same top three articles, albeit with a degree of variation in the ranking.
Qualitative and quantitative assessment of cost analyses in EBRT exhibits a fair level of study quality in terms of the methodology and reporting transparency. The impact of cost calculations on the final HEE result appears to be underestimated, and increased transparency of the data sources and the methodologies is needed.