Walley T, Barton S, Cooke J, Drummond M
Department of Pharmacology and Therapeutics, University of Liverpool, UK.
Health Policy. 1997 Jul;41(1):61-72. doi: 10.1016/s0168-8510(97)00013-4.
All health authorities in Great Britain have both medically or pharmaceutical qualified staff to advise both the authority and the local primary care medical practitioners about drug use and prescribing. This study used a piloted postal questionnaire to assess the attitudes of these advisers to economic evaluations of drug therapy, and their perceptions of the barriers to achieving cost effective prescribing by use of these evaluations. There was a 65% response rate to the questionnaire. Economic issues were rated by advisers to be less important than clinical issues, but were considered at most meetings between advisers and primary care medical practitioners. Advisers wished to consider true cost effective prescribing but often felt obliged to consider drug acquisition costs and risks of budgetary overspends. The perceived inflexibility of existing structures within the British National Health Service and the lack of credibility of the evaluations (often perceived as pharmaceutical industry marketing) were the major barriers to the application of the evaluations. The paper concludes that advisers were keen to use economic evaluations to promote cost effective prescribing but were impeded by the perceived bias of existing studies and by rigid current NHS structures.
英国所有卫生当局都有医学或药学资质的工作人员，就药物使用和处方问题为当局及当地基层医疗从业者提供建议。本研究采用一份经过试点的邮寄问卷，以评估这些顾问对药物治疗经济评估的态度，以及他们对通过使用这些评估来实现成本效益处方的障碍的看法。问卷的回复率为65%。顾问们认为经济问题不如临床问题重要，但在顾问与基层医疗从业者的大多数会议中都会被提及。顾问们希望考虑真正具有成本效益的处方，但往往觉得有必要考虑药品采购成本和预算超支的风险。英国国民医疗服务体系中现有结构缺乏灵活性以及评估缺乏可信度（常被视为制药行业的营销手段）是评估应用的主要障碍。本文得出结论，顾问们热衷于利用经济评估来促进成本效益处方，但受到现有研究的明显偏见和当前国民医疗服务体系僵化结构的阻碍。
