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Health economics research into supporting carers of people with dementia: A systematic review of outcome measures

机译：支持痴呆症患者护理人员的卫生经济学研究：对结局指标的系统评价

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Advisory bodies, such as the National Institute for Health and Clinical Excellence (NICE) in the UK, advocate using preference based instruments to measure the quality of life (QoL) component of the quality-adjusted life year ( QALY ). Cost per QALY is used to determine cost-effectiveness, and hence funding, of interventions. QALYs allow policy makers to compare the effects of different interventions across different patient groups. Generic measures may not be sensitive enough to fully capture the QoL effects for certain populations, such as carers, so there is a need to consider additional outcome measures, which are preference based where possible to enable cost-effectiveness analysis to be undertaken. This paper reviews outcome measures commonly used in health services research and health economics research involving carers of people with dementia. An electronic database search was conducted in PubMed, Medline , the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment database. Studies were eligible for inclusion if they included an outcome measure for carers of people with dementia. 2262 articles were identified. 455 articles describing 361 studies remained after exclusion criteria were applied. 228 outcome measures were extracted from the studies. Measures were categorised into 44 burden measures, 43 mastery measures, 61 mood measures, 32 QoL measures, 27 social support and relationships measures and 21 staff competency and morale measures. The choice of instrument has implications on funding decisions; therefore, researchers need to choose appropriate instruments for the population being measured and the type of intervention undertaken. If an instrument is not sensitive enough to detect changes in certain populations, the effect of an intervention may be underestimated, and hence interventions which may appear to be beneficial to participants are not deemed cost-effective and are not funded. If this is the case, it is essential that additional outcome measures which detect changes in broader QoL are included, whilst still retaining preference based utility measures such as EQ-5D to allow QALY calculation for comparability with other interventions.
机译：咨询机构，例如英国国家卫生与临床卓越研究所（NICE），提倡使用基于偏爱的工具来衡量质量调整生命年（QALY）中的生活质量（QoL）。每个QALY的费用用于确定干预措施的成本效益，从而确定经费。 QALYs使决策者能够比较不同患者群体不同干预措施的效果。通用措施可能不够灵敏，无法完全捕获某些人群（如护理人员）的QoL效应，因此有必要考虑其他结局指标，在可能的情况下，这些指标应优先考虑，以便进行成本效益分析。本文回顾了涉及痴呆症患者护理人员的卫生服务研究和卫生经济学研究中常用的结果指标。在PubMed，Medline，护理和相关健康文献累积索引（CINAHL），PsycINFO，国家卫生服务经济评估数据库（NHS EED），效果评价摘要数据库（DARE）和健康中进行了电子数据库搜索技术评估数据库。如果研究包括针对痴呆症患者护理人员的结果指标，则符合纳入条件。确定了2262篇文章。应用排除标准后，剩余455篇文章描述了361项研究。从研究中提取了228项结果指标。这些措施分为44项负担措施，43项精通措施，61项情绪措施，32项生活质量措施，27项社会支持和关系措施以及21项员工能力和士气措施。文书的选择对供资决定有影响;因此，研究人员需要为被测人群和采取的干预措施选择合适的工具。如果一种仪器不够灵敏，无法检测某些人群的变化，那么干预措施的效果可能会被低估，因此，看来对参与者有益的干预措施不被认为具有成本效益，也没有资金来源。如果是这种情况，则必须包括其他可检测更广泛的QoL变化的结果指标，同时仍保留基于偏好的效用指标（例如EQ-5D），以允许QALY计算得出与其他干预措施的可比性。

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