PICC与CVC、VPA经济学评价研究的系统评价
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摘要
目的对PICC与CVC、VPA的经济学评价研究进行系统评价,为决策者和实践者选择适宜的中心静脉输液方式提供证据。方法计算机检索国内外数据库中关于比较PICC与CVC、VPA经济学评价的文献,检索时间从建库至2018年1月4日,由2名研究者独立进行文献筛选及资料提取,采用JBI经济学评价的文献质量评价工具对纳入研究的方法学质量进行评价。结果最终纳入10篇文献,方法学质量中6篇,低4篇,主要缺陷包括未描述成本测量方法、未进行贴现、未进行敏感性分析等。10篇文献均采用了成本分析,其中7篇文献对PICC与CVC进行成本比较,各研究在置管、维护的单项成本及总成本上存在较大的差异;6篇文献对PICC和VPA进行成本比较,指出PICC置管单项成本低于VPA,维护单项成本高于VPA,而置管、维护及拔管的总成本存在差异。结论目前关于PICC与CVC、VPA经济学评价的研究数量有限,评价方法单一,且评价内容不够规范、评价方法学质量存在缺陷,导致评价结果存在较大的不一致性。尚需开展采用成本-效果/效益/效用分析的高质量、大样本、规范的经济学评价研究,从而为决策者及实践者选择适宜的中心静脉输液方式提供证据。
Objective To assess economic evaluation of PICC and Central Venous Catheter(CVC)/Venous Port Access(VPA), and to provide evidence for decision-maker and practitioner selecting suitable central venous access. Methods The literature on economic evaluation of PICC and CVC/VPA were searched through the database in domestic and overseas by computer from database building to January 4 th, 2018. Two reviewers selected the literature and extracted data independently, and the quality of included studies were assessed according to the critical appraisal of economic evaluations using the JBI ACTUARI assessment tool. Results Totally 10 studies were included, the quality of 6 studies were moderate, the other 4 were low quality, and the main defects were failing to describe the methods of cost measurement, failing to justify the discount rate, and failing to present sensitivity analysis. All studies were cost analysis, seven of which compared the cost of PICC and CVC, there were great differences on item costs and the total cost of catheterization and maintenance. And six studies compared the cost of PICC and VPA, which found the item cost of PICC catheterization was lower than that of VPA, while its item cost of maintenance was higher than that of VPA, and there was difference in the total cost of catheterization, maintenance and removal of catheter.Conclusion The research on economic evaluation of PICC and CVC/VPA is lack, and the evaluation results are inconsistent because the content and methods of economic evaluation were irregular. It is necessary to conduct high quality, large sample and regular economic evaluation research using cost-effectiveness/cost-benefit/cost-utility analysis, so as to provide evidence for decision makers and practitioners choosing suitable central venous access.
Objective To assess economic evaluation of PICC and Central Venous Catheter(CVC)/Venous Port Access(VPA), and to provide evidence for decision-maker and practitioner selecting suitable central venous access. Methods The literature on economic evaluation of PICC and CVC/VPA were searched through the database in domestic and overseas by computer from database building to January 4 th, 2018. Two reviewers selected the literature and extracted data independently, and the quality of included studies were assessed according to the critical appraisal of economic evaluations using the JBI ACTUARI assessment tool. Results Totally 10 studies were included, the quality of 6 studies were moderate, the other 4 were low quality, and the main defects were failing to describe the methods of cost measurement, failing to justify the discount rate, and failing to present sensitivity analysis. All studies were cost analysis, seven of which compared the cost of PICC and CVC, there were great differences on item costs and the total cost of catheterization and maintenance. And six studies compared the cost of PICC and VPA, which found the item cost of PICC catheterization was lower than that of VPA, while its item cost of maintenance was higher than that of VPA, and there was difference in the total cost of catheterization, maintenance and removal of catheter.Conclusion The research on economic evaluation of PICC and CVC/VPA is lack, and the evaluation results are inconsistent because the content and methods of economic evaluation were irregular. It is necessary to conduct high quality, large sample and regular economic evaluation research using cost-effectiveness/cost-benefit/cost-utility analysis, so as to provide evidence for decision makers and practitioners choosing suitable central venous access.
引文
[1] Johansson E,Hammarskjold F,Lundberg D,et al.Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines:a systematic review of the literature[J].Acta Oncol,2013,52(5):886-892.
[2] 孙红,王蕾,关欣,等.全国部分三级甲等医院静脉治疗护理现状分析[J].中华护理杂志,2014,49(10):1232-1237.
[3] Dong Z,Connolly B L,Ungar W J,et al.Cost analysis of peripherally inserted central catheter in pediatric patients[J].Int J Technol Assess Health Care,2018,34(1):38-45.
[4] Periard D,Monney P,Waeber G,et al.Randomized controlled trial of peripherally inserted central catheters vs.peripheral catheters for middle duration in-hospital intravenous therapy[J].J Thromb Haemost,2008,6(8):1281-1288.
[5] 阮叶,顾迪,高雪娟,等.肿瘤患者PICC与VPA临床应用比较的Meta分析[J].护士进修杂志,2015,30(17):1559-1562.
[6] 周英凤,胡雁,张晓菊,等.PICC输液技术有效性及安全性评估的系统评价再评价[J].护理学杂志,2016,31(7):90-94.
[7] 师佳佳,盛小燕,曹文静,等.静脉治疗肿瘤患者选择中心静脉输液装置影响因素的调查分析[J].现代临床护理,2013,12(5):1-6.
[8] 李全磊,颜美琼,林岑,等.肿瘤患者选择留置PICC真实体验的质性研究[J].护理学杂志,2012,27(5):40-42.
[9] Moss J G,Paul J,Wu O,et al.Cancer and venous access (CAVA):a randomised controlled trial with associated qualitative research of venous access devices for delivering long-term chemotherapy[J].Cardiovasc Intervent Radiol,2017,40(2):S142-S143.
[10] The Joanna Briggs Institute reviewers′ manual 2014:the systematic review of economic evaluation evidence[EB/OL].(2018-05-11)[2018-04-20].https://wiki.joannabriggs.org/display/MANUAL/Chapter+6%3A+Systematic+reviews+of+economic+evidence.
[11] Rotzinger R,Gebauer B,Schnapauff D,et al.Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radio-logy department:analysis of costs and intervention duration learning curve[J].Acta Radiologica,2017,58(12):1468-1475.
[12] Martella F,Salutari V,Marchetti C,et al.A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters:a multicentric Italian experience[J].Anti-Cancer Drugs,2015,26(9):990-994.
[13] Patel G S,Jain K,Kumar R,et al.Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies[J].Support Care Cancer,2014,22(1):121-128.
[14] 刘芳,方少梅,邱丽文,等.肿瘤患者化疗中2种深静脉置管应用效果及专项护理成本比较[J].中国实用护理杂志,2011,27(34):8-10.
[15] Cowl C T,Weinstock J V,Al-Jurf A,et al.Complications and cost associated with parenteral nutrition deli-vered to hospitalized patients through either subclavian or peripherally-inserted central catheters[J].Clin Nutr,2000,19(4):237-243.
[16] Major B M,Crow M M.Peripherallyinserted central catheters in the patient with cardiomyopathy.The most cost-effective venous acess[J].J Intraven Nurs,2000,23(6):366-370.
[17] Raad I,Davis S,Becker M,et al.Low infection rate and long durability of nontunneled silastic catheters.A safe and cost-effective alternative for long-term venous access[J].Arch Intern Med,1993,153(15):1791-1796.
[18] Fang S,Yang J,Song L,et al.Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy[J].Patient Prefer Adherence,2017,11:1197-1204.
[19] Horattas M C,Trupiano J,Hopkins S,et al.Changing concepts in long-term central venous access:Catheter selection and cost savings[J].Am J Infect Control,2001,29(1):32-40.
[20] Smith J R,Friedell M L,Cheatham M L,et al.Periphe-rally inserted central catheters revisited[J].Am J Surg,1998,176(2):208-211.
[2] 孙红,王蕾,关欣,等.全国部分三级甲等医院静脉治疗护理现状分析[J].中华护理杂志,2014,49(10):1232-1237.
[3] Dong Z,Connolly B L,Ungar W J,et al.Cost analysis of peripherally inserted central catheter in pediatric patients[J].Int J Technol Assess Health Care,2018,34(1):38-45.
[4] Periard D,Monney P,Waeber G,et al.Randomized controlled trial of peripherally inserted central catheters vs.peripheral catheters for middle duration in-hospital intravenous therapy[J].J Thromb Haemost,2008,6(8):1281-1288.
[5] 阮叶,顾迪,高雪娟,等.肿瘤患者PICC与VPA临床应用比较的Meta分析[J].护士进修杂志,2015,30(17):1559-1562.
[6] 周英凤,胡雁,张晓菊,等.PICC输液技术有效性及安全性评估的系统评价再评价[J].护理学杂志,2016,31(7):90-94.
[7] 师佳佳,盛小燕,曹文静,等.静脉治疗肿瘤患者选择中心静脉输液装置影响因素的调查分析[J].现代临床护理,2013,12(5):1-6.
[8] 李全磊,颜美琼,林岑,等.肿瘤患者选择留置PICC真实体验的质性研究[J].护理学杂志,2012,27(5):40-42.
[9] Moss J G,Paul J,Wu O,et al.Cancer and venous access (CAVA):a randomised controlled trial with associated qualitative research of venous access devices for delivering long-term chemotherapy[J].Cardiovasc Intervent Radiol,2017,40(2):S142-S143.
[10] The Joanna Briggs Institute reviewers′ manual 2014:the systematic review of economic evaluation evidence[EB/OL].(2018-05-11)[2018-04-20].https://wiki.joannabriggs.org/display/MANUAL/Chapter+6%3A+Systematic+reviews+of+economic+evidence.
[11] Rotzinger R,Gebauer B,Schnapauff D,et al.Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radio-logy department:analysis of costs and intervention duration learning curve[J].Acta Radiologica,2017,58(12):1468-1475.
[12] Martella F,Salutari V,Marchetti C,et al.A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters:a multicentric Italian experience[J].Anti-Cancer Drugs,2015,26(9):990-994.
[13] Patel G S,Jain K,Kumar R,et al.Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies[J].Support Care Cancer,2014,22(1):121-128.
[14] 刘芳,方少梅,邱丽文,等.肿瘤患者化疗中2种深静脉置管应用效果及专项护理成本比较[J].中国实用护理杂志,2011,27(34):8-10.
[15] Cowl C T,Weinstock J V,Al-Jurf A,et al.Complications and cost associated with parenteral nutrition deli-vered to hospitalized patients through either subclavian or peripherally-inserted central catheters[J].Clin Nutr,2000,19(4):237-243.
[16] Major B M,Crow M M.Peripherallyinserted central catheters in the patient with cardiomyopathy.The most cost-effective venous acess[J].J Intraven Nurs,2000,23(6):366-370.
[17] Raad I,Davis S,Becker M,et al.Low infection rate and long durability of nontunneled silastic catheters.A safe and cost-effective alternative for long-term venous access[J].Arch Intern Med,1993,153(15):1791-1796.
[18] Fang S,Yang J,Song L,et al.Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy[J].Patient Prefer Adherence,2017,11:1197-1204.
[19] Horattas M C,Trupiano J,Hopkins S,et al.Changing concepts in long-term central venous access:Catheter selection and cost savings[J].Am J Infect Control,2001,29(1):32-40.
[20] Smith J R,Friedell M L,Cheatham M L,et al.Periphe-rally inserted central catheters revisited[J].Am J Surg,1998,176(2):208-211.