Salkeld G, Davey P, Arnolda G
Department of Public Health, University of Sydney, New South Wales.
Health Policy. 1995 Feb;31(2):111-25. doi: 10.1016/0168-8510(94)00672-5.
In Australia, as in many other countries, economic evaluation is increasingly seen by health care policy makers as a useful aid to priority setting and resource allocation. In Australia, economic evaluation is now a requirement for new drugs to be listed on the Pharmaceutical Benefits Scheme which provides a government subsidy on the price of listed drugs for purchasers. Yet, despite recognition of the importance of economic evaluation by policy makers, there is a paucity of published evaluations in Australia. We reviewed all of the 33 health-related economic evaluations conducted in Australia and subsequently published since 1978. This study assesses how well informed decision makers might be if they used the results and conclusions of published economic evaluations as an aid to resource allocation. The review highlights several issues: (i) it is difficult to interpret the conclusions or assess the generalisability of individual papers without information on the context of the original study; (ii) the choice of comparator(s) was often unexplained and most papers did not employ marginal analysis; (iii) in the absence of marginal analysis, the comparability of cost-effectiveness ratios in league tables must be questioned as well as the completeness (were all the relevant alternatives included?) of studies; and (iv) the quality of effectiveness evidence varies enormously, with some authors content to use the best available evidence (even if it is of poor quality). The development of standards for economic evaluation methods might ensure a more consistent and scientific approach to evaluative work, but they cannot guarantee it. A more concerted effort to disseminate the principles and methods of economic evaluation to policy makers and non-economist evaluators might be a more important precursor to improving the credibility and usefulness of economic evaluations in priority setting.
在澳大利亚，如同许多其他国家一样，医疗保健政策制定者越来越将经济评估视为确定优先事项和资源分配的有用辅助手段。在澳大利亚，经济评估如今是新药列入药品福利计划的一项要求，该计划为购买者提供政府对所列药品价格的补贴。然而，尽管政策制定者认识到经济评估的重要性，但澳大利亚已发表的评估却很少。我们回顾了自1978年以来在澳大利亚进行并随后发表的所有33项与健康相关的经济评估。本研究评估了决策者若将已发表的经济评估结果和结论用作资源分配辅助手段时，其信息掌握程度如何。该综述突出了几个问题：（i）如果没有关于原始研究背景的信息，就难以解释结论或评估个别论文的普遍性；（ii）比较对象的选择往往未作解释，而且大多数论文未采用边际分析；（iii）在没有边际分析的情况下，排行榜中成本效益比的可比性以及研究的完整性（是否涵盖了所有相关替代方案？）都必须受到质疑；（iv）有效性证据的质量差异极大，一些作者满足于使用现有最佳证据（即使质量很差）。经济评估方法标准的制定可能会确保评估工作采用更一致和科学的方法，但无法保证做到这一点。更协调一致地努力向政策制定者和非经济学家评估人员传播经济评估的原则和方法，可能是提高经济评估在确定优先事项方面的可信度和实用性的更重要前提。
