背景:需要有可靠的信息来决定医疗资源的分配,以改善饮食失调(ED)患者的福祉和生活质量。ED是全球医疗保健管理员的主要关注点,特别是由于健康影响的严重性,紧急和复杂的医疗保健需求,以及相对较高的长期医疗费用。对ED干预措施的最新健康经济证据进行严格评估对于为该领域的决策提供信息至关重要。迄今为止,关于这一主题的卫生经济评论缺乏对潜在临床效用的全面评估,使用的资源类型和数量,和纳入经济评价的方法学质量。当前的审查旨在(1)详细说明成本的类型(直接和间接),成本计算方法,对健康的影响,和ED干预措施的成本效益;(2)评估现有证据的性质和质量,以提供与ED相关的健康经济学有意义的见解。
方法:所有筛查干预措施,预防,治疗,以及所有诊断和统计手册(DSM-IV和DSM-5)列出的儿童ED的基于政策的方法,青少年,成年人将包括在内。将考虑一系列研究设计,包括随机对照试验,小组研究,队列研究,和准实验试验。经济评估将考虑关键成果,包括使用的资源类型(时间和以货币计价),成本(直接和间接),成本计算方法,健康影响(临床和生活质量),成本效益,使用的经济摘要,报告和质量评估。将使用主题标题和合并成本的关键字搜索15个通用学术和特定领域(心理学和经济学)数据库,对健康的影响,成本效益和ED。纳入的临床研究的质量将使用偏倚风险工具进行评估。经济研究的报告和质量将使用广泛接受的综合卫生经济评估报告标准和卫生经济研究质量框架进行评估。审查结果在表格和叙述中呈现。
结论:本系统评价产生的结果预计将突出医疗保健干预/政策为重点的方法方面的差距,低估了经济成本和疾病负担,潜在的ED相关资源利用不足,迫切需要更全面的卫生经济评估。
BACKGROUND: Having reliable information to make decisions about the allocation of healthcare resources is needed to improve well-being and quality-of-life of individuals with eating disorders (EDs). EDs are a main concern for healthcare administrators globally, particularly due to the severity of health effects, urgent and complex healthcare needs, and relatively high and long-term healthcare costs. A rigorous assessment of up-to-date health economic evidence on interventions for EDs is essential for informing decision-making in this area. To date, health economic reviews on this topic lack a comprehensive assessment of the underlying clinical utility, type and amount of resources used, and methodological quality of included economic evaluations. The current review aims to (1) detail the type of costs (direct and indirect), costing approaches, health effects, and cost-effectiveness of interventions for EDs; (2) assess the nature and quality of available evidence to provide meaningful insights into the health economics associated with EDs.
METHODS: All interventions for screening, prevention, treatment, and policy-based approaches for all Diagnostic and Statistics Manual (DSM-IV and DSM-5) listed EDs among children, adolescents, and adults will be included. A range of study designs will be considered, including randomised controlled trials, panel studies, cohort studies, and quasi-experimental trials. Economic evaluations will consider key outcomes, including type of resources used (time and valued in a currency), costs (direct and indirect), costing approach, health effects (clinical and quality-of-life), cost-effectiveness, economic summaries used, and reporting and quality assessments. Fifteen general academic and field-specific (psychology and economics) databases will be searched using subject headings and keywords that consolidate costs, health effects, cost-effectiveness and EDs. Quality of included clinical studies will be assessed using risk-of-bias tools. Reporting and quality of the economic studies will be assessed using the widely accepted Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies frameworks, with findings of the review presented in tables and narratively.
CONCLUSIONS: Results emanating from this systematic review are expected to highlight gaps in healthcare interventions/policy-focused approaches, under-estimates of the economic costs and disease-burden, potential under-utilisation of ED-related resources, and a pressing need for more complete health economic evaluations.