Gerard K
Health Economics Research Unit, University of Aberdeen, Scotland, UK.
Health Policy. 1992 Jul;21(3):249-79. doi: 10.1016/0168-8510(92)90022-4.
In recent years QALYs (quality adjusted life years) have achieved considerable fame or perhaps even notoriety in health services policy making. Yet little has been done to date to assess the potential benefit in policy terms of studies that have used cost-utility analysis (CUA). It was in recognition of this fact that this particular investigation was undertaken. An evaluation of 51 cost-utility studies is reported in the paper. Several criteria were applied to each study including aspects of technical and policy relevance. The main findings were: few studies had been undertaken; they were limited to few areas of health care; their technical execution was often of poor quality; the majority of studies used the empirical findings of health state valuations obtained from original developers of different quality of life techniques; and many claimed their results to be 'favourable' (i.e. efficient interventions). This claim, however, is misguided because individual results get fed into generalised QALY league tables which ignore the context of specific studies and use results not performed on a common basis. Consequently, the state of the applied art of CUA is currently open to considerable question.
近年来，质量调整生命年（QALYs）在卫生服务政策制定领域声名大噪，甚至可以说是恶名远扬。然而，迄今为止，对于那些采用成本效用分析（CUA）的研究在政策层面的潜在益处，几乎未作评估。正是认识到这一事实，才开展了此项具体调查。本文报告了对51项成本效用研究的评估情况。对每项研究都应用了若干标准，包括技术和政策相关性等方面。主要研究结果如下：开展的研究较少；研究局限于少数医疗保健领域；其技术实施质量往往较差；大多数研究采用了从不同生活质量技术的原始开发者那里获得的健康状态估值的实证结果；许多研究称其结果是“有利的”（即有效的干预措施）。然而，这种说法是错误的，因为个别结果被纳入了通用的QALY排行榜，而这些排行榜忽略了具体研究的背景情况，并且使用的结果并非基于共同的基础得出。因此，目前成本效用分析的应用现状存在很大问题。
