Golder W
Abteilung Radiologie und Nuklearmedizin, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
Rofo. 1999 Jan;170(1):73-9. doi: 10.1055/s-2007-1011010.
Cost efficiency analyses in clinical radiology require the application of methods and techniques that are not yet part of the academic qualifications of the specialists. The procedures used are borrowed from economics, decision theory, applied social sciences, epidemiology and statistics. Many expressions hail from the angloamerican literature and are presently not yet germanized unequivocally. This survey is intended to present main terms of cost efficiency analysis in the english version as well as a german translation, to give a clear definition and, if necessary, explanatory notes, and to illustrate their application by means of concrete radiologic examples. The selection of the terms is based on the hierarchical models of health technology assessment resp. clinical outcome research by Fryback & Thornbury resp. Maisey & Hutton. In concrete terms, both the differences between benefit, outcomes, and utility and the differences between effectiveness, efficacy and efficiency and the differences between direct, indirect, intangible, and marginal costs are explained. True cost efficiency analysis is compared with cost effectiveness analysis, cost identification analysis, cost minimization analysis, and cost utility analysis. Applied social sciences are represented by the Medical Outcomes Study Short Form-36 and the QALY conception. From decision theory both the analysis of hypothetical alternatives and the Markov model are taken. Finally, sensitivity analysis and the procedures of combined statistical evaluation of comparable results (meta-analysis) are quoted.
临床放射学中的成本效益分析需要运用一些方法和技术,而这些方法和技术并非放射科专家学术资质的一部分。所采用的程序借鉴了经济学、决策理论、应用社会科学、流行病学和统计学。许多术语源自英美文献,目前尚未完全德语化。本综述旨在呈现英文版成本效益分析的主要术语及其德文翻译,给出清晰定义,并在必要时附上解释性注释,同时通过具体的放射学实例说明其应用。术语的选取基于卫生技术评估的分层模型,分别参考了弗莱巴克和桑伯里以及梅西和赫顿的临床结局研究。具体而言,解释了效益、结局和效用之间的差异,有效性、效能和效率之间的差异,以及直接成本、间接成本、无形成本和边际成本之间的差异。将真正的成本效益分析与成本效果分析、成本识别分析、成本最小化分析和成本效用分析进行了比较。应用社会科学以医学结局研究简表36和质量调整生命年概念为例进行了介绍。决策理论方面引用了假设替代方案分析和马尔可夫模型。最后,引用了敏感性分析以及对可比结果进行联合统计评估的程序(荟萃分析)。