Ryan M
Department of Public Health, University of Aberdeen Medical School, Foresterhill, UK.
Soc Sci Med. 1999 Feb;48(4):535-46. doi: 10.1016/s0277-9536(98)00374-8.
There has been an assumption in the health economics literature that health outcomes are all that need to be considered when attempting to measure the benefits from health care interventions. This is most evident in the development of the quality adjusted life year (QALY) approach to benefit assessment. This paper challenges this view and considers the technique of conjoint analysis (CA) as a methodology for both taking account of patient preferences and considering attributes beyond health outcomes. The technique is applied to in vitro fertilisation. CA is shown to be sensitive to considering health outcomes, nonhealth outcomes and process attributes. It is also shown to be internally consistent and internally valid. The paper demonstrates the application of CA to estimating willingness to pay indirectly. It is argued that benefit assessment within health economics should extend beyond health outcomes and future research should investigate more thoroughly the potential application of CA in this area. However, methodological issues need addressing before the instrument becomes an established evaluative instrument.
卫生经济学文献中一直存在一种假设，即在试图衡量医疗保健干预措施的益处时，健康结果是唯一需要考虑的因素。这在用于效益评估的质量调整生命年（QALY）方法的发展中最为明显。本文对这一观点提出了挑战，并将联合分析（CA）技术视为一种既考虑患者偏好又考虑健康结果以外属性的方法。该技术被应用于体外受精。结果表明，联合分析对考虑健康结果、非健康结果和过程属性很敏感。它还具有内部一致性和内部有效性。本文展示了联合分析在间接估计支付意愿方面的应用。有人认为，卫生经济学中的效益评估应超越健康结果，未来的研究应更深入地调查联合分析在该领域的潜在应用。然而，在该工具成为既定的评估工具之前，方法学问题需要解决。
