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Chi Phí - Hiệu Quả của Các Phương Pháp Điều Trị Quản Lý Di Căn Xương: Một Tổng Quan Tài Liệu Hệ Thống
Tóm tắt
Ung thư di căn xảy ra khi các tế bào ung thư tách rời khỏi khối u nguyên phát. Một trong những vị trí di căn phổ biến nhất là xương, với một số lựa chọn điều trị hiện có để quản lý di căn xương. Trong một môi trường hạn chế nguồn lực, các nhà hoạch định chính sách và chuyên gia cần biết đâu là những lựa chọn có chi phí hiệu quả. Mục tiêu của tổng quan có hệ thống này là xem xét và đánh giá các đánh giá kinh tế đã được công bố về các phương pháp điều trị cho việc quản lý di căn xương. Chúng tôi đã tìm kiếm tám cơ sở dữ liệu tài liệu (MEDLINE, MEDLINE đang trong quá trình, EMBASE, CSDR, DARE, HTA, EED và CPCI) để tìm các đánh giá kinh tế liên quan được công bố từ ngày thành lập của mỗi cơ sở dữ liệu cho đến tháng 3 năm 2017. Việc lựa chọn nghiên cứu, đánh giá chất lượng và trích xuất dữ liệu được thực hiện theo các hướng dẫn đã công bố. Hai mươi bốn phân tích kinh tế liên quan đã được xác định. Mười bảy trong số các nghiên cứu này tập trung vào di căn xương do một số loại ung thư cụ thể, tức là ung thư tuyến tiền liệt (n = 8), ung thư vú (n = 7), ung thư phổi (n = 1) hoặc ung thư thận (n = 1), trong khi bảy nghiên cứu báo cáo kết quả cho các khối u nguyên phát khác nhau. Trong các loại ung thư, bằng chứng cho thấy rằng bisphosphonates dẫn đến tỷ lệ bệnh tật thấp hơn và chất lượng cuộc sống được cải thiện, với chi phí bổ sung, thường dưới ngưỡng chi phí - hiệu quả thông thường. Trong khi denosumab dẫn đến lợi ích sức khỏe so với axit zoledronic, nó cũng tạo ra chi phí bổ sung đáng kể và không có khả năng đại diện cho giá trị hợp lý. Tài liệu hạn chế về thuốc phóng xạ strontium-89 (Sr89) và xạ trị chùm ngoài (EBR) cho thấy rằng các phương pháp điều trị này có chi phí hiệu quả so với không điều trị. Bằng chứng được xem xét cho thấy rằng các phương pháp điều trị bisphosphonate là các lựa chọn có chi phí - hiệu quả cho di căn xương, trong khi denosumab không có khả năng đại diện cho giá trị hợp lý. Bằng chứng về EBR và Sr89 còn hạn chế và ít kết luận.
Từ khóa
#ung thư di căn #di căn xương #đánh giá kinh tế #bisphosphonates #denosumab #strontium-89 #xạ trị chùm ngoàiTài liệu tham khảo
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