中美两国医保预算影响分析研究文献的质量评估
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摘要
目的:为我国医保预算影响分析(BIA)研究的开展提供经验借鉴。方法:在PubMed、ProQuest、中国知网、万方和中国生物医学文献服务系统等数据库中检索建库至今的中美两国关于医保BIA研究的相关文献,对其基本信息、分析结果和数据来源等内容进行归纳和整理,并基于模型设计、研究角度、治疗成本、参考情景、目标人群、研究时限及贴现/通货膨胀、敏感性分析这7个关键要素对纳入文献进行描述性分析。结果:本研究共纳入72篇文献,其中中国研究24项(33.33%),美国地区研究48项(66.67%);适应证为慢性病的相关研究有45项(62.50%),急性病的相关研究有21项(37.50%);研究方法上,单独使用BIA的有49项(68.06%),联用BIA和药物经济学评价的有23项(31.94%);模型设计方面,有50项(69.44%)研究采用了成本计算模型;研究角度方面,有60项(83.33%)研究基于医保部门研究视角;治疗成本的计算中,有69项(95.84%)研究包含了药品费用;参考情景方面,有61项(84.72%)研究对比了以药物为主的不同治疗组合的经济性;目标人群方面,仅有31项(43.06%)研究采用了真实世界数据;研究时限及贴现/通货膨胀方面,有14项(19.44%)研究使用治疗疗程或住院时长表示研究时限,19项(26.39%)研究使用了贴现率或通货膨胀率调整成本;敏感性分析方面,有62项(86.11%)研究做了敏感性分析,其中49项(68.06%)研究采用了单因素敏感性分析。结论:中美两国医保BIA研究文献尚存在数据使用不合理、成本范围涵盖不全和敏感性分析因变量变化范围不合理等局限。建议BIA研究应规范数据来源,提高预算证据质量;合理评估市场规模,提高预测真实性;科学设置变量和变化范围,提升结果稳健性;建立BIA研究范式或评级标准,科学指导BIA研究。
OBJECTIVE:To provide experience and reference for the study of medical insurance budget impact analysis(BIA)in China. METHODS:Retrieved from PubMed,ProQuest,CNKI,Wanfang database and CBM,related literatures about medical insurance BIA research in China and the United States were collected since the establishment of the database. The basic information,analysis results and data sources were summarized and sorted out,and descriptive analysis of the included literature was carried out on basis of seven key elements such as model design,research perspective,treatment cost,reference scenario,target population,research time limit and discount/inflation,sensitivity analysis. RESULTS:A total of 72 literatures were included in this study,involving 24(33.33%)studies in China,48(66.67%)studies in the United States;the indications of 45 studies were chronic diseases(62.50%),and those of 21 studies were acute diseases(37.50%). Among the research methods,49 studies(68.06%)used BIA alone and 23 studies(31.94%)adopted BIA combined with pharmaceutical economics. In terms of model design,50 studies(69.44%)adopted cost calculation models. In terms of research perspective,60 studies(81.94%)were based on the perspective of medical insurance department research. In the calculation of treatment cost,69 studies(95.84%) included drug cost. In terms of reference scenarios,61 studies(84.72%)compared the economics of different drug-based treatment groups.For target population,only 31(43.06%) studies used real world data. In terms of research duration and discount/inflation,14 studies(19.44%)used treatment or length of hospitalization to indicate research duration,and 19 studies(26.39%)used discount rate or inflation rate to adjust costs. As for sensitivity analysis,62 studies(86.11%)conducted sensitivity analysis,of which 49 (68.06%) used single factor sensitivity analysis.CONCLUSIONS:There are still some limitations in medical insurance BIA research literature in China and the United States,such as unreasonable use of data,incomplete coverage of the cost,and unreasonable setting of sensitivity analysis variables. It is recommended that BIA research should standardize data sources to improve the quality of budget evidence quality,reasonably evaluate market size to improve the authenticity of prediction,scientifically set variables and their scope of change to improve the stability of results,establish BIA research paradigms or evaluating standards so as to guide BIA research scientifically.
OBJECTIVE:To provide experience and reference for the study of medical insurance budget impact analysis(BIA)in China. METHODS:Retrieved from PubMed,ProQuest,CNKI,Wanfang database and CBM,related literatures about medical insurance BIA research in China and the United States were collected since the establishment of the database. The basic information,analysis results and data sources were summarized and sorted out,and descriptive analysis of the included literature was carried out on basis of seven key elements such as model design,research perspective,treatment cost,reference scenario,target population,research time limit and discount/inflation,sensitivity analysis. RESULTS:A total of 72 literatures were included in this study,involving 24(33.33%)studies in China,48(66.67%)studies in the United States;the indications of 45 studies were chronic diseases(62.50%),and those of 21 studies were acute diseases(37.50%). Among the research methods,49 studies(68.06%)used BIA alone and 23 studies(31.94%)adopted BIA combined with pharmaceutical economics. In terms of model design,50 studies(69.44%)adopted cost calculation models. In terms of research perspective,60 studies(81.94%)were based on the perspective of medical insurance department research. In the calculation of treatment cost,69 studies(95.84%) included drug cost. In terms of reference scenarios,61 studies(84.72%)compared the economics of different drug-based treatment groups.For target population,only 31(43.06%) studies used real world data. In terms of research duration and discount/inflation,14 studies(19.44%)used treatment or length of hospitalization to indicate research duration,and 19 studies(26.39%)used discount rate or inflation rate to adjust costs. As for sensitivity analysis,62 studies(86.11%)conducted sensitivity analysis,of which 49 (68.06%) used single factor sensitivity analysis.CONCLUSIONS:There are still some limitations in medical insurance BIA research literature in China and the United States,such as unreasonable use of data,incomplete coverage of the cost,and unreasonable setting of sensitivity analysis variables. It is recommended that BIA research should standardize data sources to improve the quality of budget evidence quality,reasonably evaluate market size to improve the authenticity of prediction,scientifically set variables and their scope of change to improve the stability of results,establish BIA research paradigms or evaluating standards so as to guide BIA research scientifically.
引文
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