Russell L B, Fryback D G, Sonnenberg F A
Institute for Health Care Policy, Rutgers University, New Brunswick, NJ 08903, USA.
Jt Comm J Qual Improv. 1999 Sep;25(9):447-54. doi: 10.1016/s1070-3241(16)30458-8.
The U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine recommends that cost-effectiveness analyses (CEAs) intended to help allocate health resources in the public interest include a reference case analysis, conducted from the perspective of society as a whole. This perspective requires that an analysis measure all health effects and changes in resource use caused by an intervention. VALUE OF SOCIETAL CEAs: Tensions unavoidably arise among the parties to medical decisions--patients, their families and friends, clinicians, and third-party payers. One common approach to handling these tensions is to ignore some of them, to "solve" them by pretending they do not or should not exist. Patients do this when they demand the best care for themselves without regard to the cost to others, payers when they make coverage decisions that shift costs ot others. But by estimating all gains and losses, calculations that reflect the safety, effectiveness, and side effects of an intervention as well as its costs, societal CEAs can help resolve those tensions and provide the basis for decisions that are fair to all parties, an agenda for negotiating such decisions, and information essential for designing compensation and incentives to support them. MAKING BETTER USE OF SOCIETAL CEAs: Use of the societal perspective asks that all parties be aware of and consider the interests of others. Some process or procedure needs to be developed for presenting CEA information to the parties most likely to be affected by decisions, soliciting their views, and negotiating an acceptable decision. This process could be used by government decision makers or by managed care organizations, professional societies, or payers.
美国公共卫生服务部健康与医学成本效益小组建议,旨在帮助以公共利益分配卫生资源的成本效益分析(CEA)应包括从整个社会角度进行的参考案例分析。这种角度要求分析衡量干预措施所导致的所有健康影响和资源使用变化。社会成本效益分析的价值:在医疗决策的各方——患者、其家人和朋友、临床医生以及第三方支付者之间,不可避免地会出现紧张关系。处理这些紧张关系的一种常见方法是忽略其中一些,通过假装它们不存在或不应存在来“解决”它们。患者在要求为自己提供最佳治疗而不考虑对他人的成本时会这样做,支付者在做出将成本转嫁给他人的承保决策时也会这样做。但是,通过估计所有的收益和损失,反映干预措施的安全性、有效性、副作用及其成本的计算,社会成本效益分析可以帮助解决这些紧张关系,并为对所有各方都公平的决策、谈判此类决策的议程以及设计支持这些决策的补偿和激励措施所需的信息提供基础。更好地利用社会成本效益分析:采用社会角度要求所有各方意识到并考虑他人的利益。需要制定一些流程或程序,以便向最可能受决策影响的各方提供成本效益分析信息,征求他们的意见,并协商出一个可接受的决策。政府决策者、管理式医疗组织、专业协会或支付者都可以使用这个流程。