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目的:对国际发表的临终患者姑息治疗的临床随机对照研究(randomized controlled trail,RCT)的成本-效果评估文献进行系统综述,为我国支付及临床决策提供姑息疗法成本和成本-效果研究依据。方法:纳入2000年至2015年间国际发表的姑息治疗和常规治疗的RCT研究文献,对姑息治疗临床产出、相关成本及成本-效果研究进行汇总。结果:最终有6项RCT研究纳入本次系统综述分析。结果显示与常规治疗相比,在临终阶段实施姑息治疗不仅可以使患者的临床症状控制平稳、生命质量提高、缓解抑郁情绪、照顾满意度提高,而且患者生存期不会缩短,甚至延长。对临床资源使用情况显示,姑息治疗更少采用激进治疗,因此带来医疗费用的大量节省。结论:对临终期患者实施姑息治疗具有非常好的成本-效果优势,我国积极推动姑息治疗将会带来巨大的临床收益,并提高医疗资源的使用效率。
OBJECTIVE: To systematically review the literature on cost-effectiveness assessment of randomized controlled trail (RCT) of palliative care in patients with terminally ill endings in China and to provide palliative care cost and cost-effectiveness evidence for our country’s payment and clinical decision-making. METHODS: The RCT literature on palliative care and routine care published between 2000 and 2015 was included to summarize the clinical outcomes of palliative care, related costs, and cost-effectiveness studies. Results: Finally, six RCT studies were included in this systematic review. The results showed that palliative treatment in the dying phase can not only stabilize the clinical symptoms, improve the quality of life, relieve the depression, improve the satisfaction of care, but also shorten the life span of patients and prolong the life span. The use of clinical resources has shown that palliative treatment uses less aggressive treatment, resulting in substantial savings in medical costs. Conclusions: The implementation of palliative treatment for patients with end-stage disease has a very good cost-effectiveness advantage. Preemptive treatment by our country will bring tremendous clinical benefits and improve the utilization efficiency of medical resources.