Buskens E
Universitair Medisch Centrum, Julius Centrum voor Patiëntgebonden Onderzoek, Utrecht.
Ned Tijdschr Geneeskd. 2000 Mar 25;144(13):622-6.
'Medical technology assessment' means investigating the developments, costs and effects of medical technologies. Practising physicians increasingly are confronted with consequences of management based on such research results. In order to follow and participate in the discussion they should be aware of this and know the jargon. In policy problems, measures of effect in natural units (e.g. cardiovascular mortality) offer advantages over measures of clinical findings (e.g. decrease of the serum cholesterol levels). Survival in various health states and disorders can be compared by multiplying the number of life years gained by a factor for the quality of life in those years. Costs are usually expressed in monetary terms. These may be calculated as direct medical costs on the basis of fees or actual costs for society. The latter is the case when the balancing is based on a societal perspective. The societal perspective enables a more objective assessment of health effects than when a patient perspective is used. 'Incremental cost effectiveness' expresses where extra expenditures will have maximum effect, and bears higher relevance for policy decisions than mean costs per unit of effect. Immaterial matters are more difficult to assess, but should nevertheless be considered in selecting the policy to be implemented.
“医疗技术评估”是指对医疗技术的发展、成本和效果进行调查。执业医师越来越多地面临基于此类研究结果的管理所带来的后果。为了跟上并参与讨论,他们应该意识到这一点并了解相关术语。在政策问题中,以自然单位衡量的效果指标(如心血管疾病死亡率)比临床发现指标(如血清胆固醇水平降低)更具优势。通过将获得的生命年数乘以这些年份的生活质量系数,可以比较不同健康状态和疾病下的生存情况。成本通常以货币形式表示。这些成本可以根据费用或社会实际成本计算为直接医疗成本。当基于社会视角进行权衡时就是这种情况。与采用患者视角相比,社会视角能够对健康效果进行更客观的评估。“增量成本效益”表明额外支出将在何处产生最大效果,并且对于政策决策而言,它比每单位效果的平均成本更具相关性。非物质因素更难评估,但在选择要实施的政策时仍应予以考虑。