目的:恶性血液病患者可能发生低丙种球蛋白血症。免疫球蛋白(Ig)通常用于预防感染,但它的总成本和成本效益是未知的。
方法:根据PRISMA指南进行了系统评价,以评估Ig的成本和成本效益的证据,静脉内(IVIg)或皮下(SCIg)给药,成人血液系统恶性肿瘤。
结果:六项研究符合纳入标准,仅确定了两项经济评估;一项IVIg与无Ig的成本效用分析(CUA),和另一个比较IVIg与SCIg。证据的质量很低。与没有治疗相比,Ig降低了住院率。一项研究报告说,在减少IVIg使用的计划之后,住院率没有显着变化。一项比较IVIg和SCIg的观察性研究表明,SCIg的住院次数更多,但每位患者的总费用更低.比较IVIg和无Ig的CUA表明IVIg治疗不划算,另一个将IVIg与SCIg进行比较的CUA发现,基于家庭的SCIg比IVIg更具成本效益,但两项研究都有严重的局限性.
结论:我们的综述强调了文献中的关键空白:血液系统恶性肿瘤患者使用Ig的成本-效果非常不确定。尽管在全球范围内使用Ig,关于治疗的直接和间接总成本的数据有限,Ig的最佳使用以及对医疗保健资源使用和成本的下游影响仍不清楚。鉴于缺乏关于Ig治疗在这一人群中的成本和成本效益的证据,进一步的卫生经济研究是必要的。
OBJECTIVE: Patients with hematological malignancies are likely to develop hypogammaglobulinemia. Immunoglobulin (Ig) is commonly given to prevent infections, but its overall costs and cost-effectiveness are unknown.
METHODS: A systematic
review was conducted following the PRISMA guidelines to assess the evidence on the costs and cost-effectiveness of Ig, administered intravenously (IVIg) or subcutaneously (SCIg), in adults with hematological malignancies.
RESULTS: Six studies met the inclusion criteria, and only two economic evaluations were identified; one cost-utility analysis (CUA) of IVIg versus no Ig, and another comparing IVIg with SCIg. The quality of the evidence was low. Compared to no treatment, Ig reduced hospitalization rates. One study reported no significant change in hospitalizations following a program to reduce IVIg use, and an observational study comparing IVIg with SCIg suggested that there were more hospitalizations with SCIg but lower overall costs per patient. The CUA comparing IVIg versus no Ig suggested that IVIg treatment was not cost-effective, and the other CUA comparing IVIg to SCIg found that home-based SCIg was more cost-effective than IVIg, but both studies had serious limitations.
CONCLUSIONS: Our
review highlighted key gaps in the literature: the cost-effectiveness of Ig in patients with hematological malignancies is very uncertain. Despite increasing Ig use worldwide, there are limited data regarding the total direct and indirect costs of treatment, and the optimal use of Ig and downstream implications for healthcare resource use and costs remain unclear. Given the paucity of evidence on the costs and cost-effectiveness of Ig treatment in this population, further health economic research is warranted.