Murray C J, Evans D B, Acharya A, Baltussen R M
Global Programme on Evidence for Health Policy, WHO, Geneva, Switzerland.
Health Econ. 2000 Apr;9(3):235-51. doi: 10.1002/(sici)1099-1050(200004)9:3<235::aid-hec502>3.0.co;2-o.
The growing use of cost-effectiveness analysis (CEA) to evaluate specific interventions is dominated by studies of prospective new interventions compared with current practice. This type of analysis does not explicitly take a sectoral perspective in which the costs and effectiveness of all possible interventions are compared, in order to select the mix that maximizes health for a given set of resource constraints. WHO guidelines on generalized CEA propose the application of CEA to a wide range of interventions to provide general information on the relative costs and health benefits of different interventions in the absence of various highly local decision constraints. This general approach will contribute to judgements on whether interventions are highly cost-effective, highly cost-ineffective, or something in between. Generalized CEAs require the evaluation of a set of interventions with respect to the counterfactual of the null set of the related interventions, i.e. the natural history of disease. Such general perceptions of relative cost-effectiveness, which do not pertain to any specific decision-maker, can be a useful reference point for evaluating the directions for enhancing allocative efficiency in a variety of settings. The proposed framework allows the identification of current allocative inefficiencies as well as opportunities presented by new interventions.
成本效益分析（CEA）在评估特定干预措施方面的应用日益增多，目前主要是对前瞻性新干预措施与现行做法进行比较研究。这种分析类型并未明确从部门角度出发，全面比较所有可能干预措施的成本和效益，以便在给定的资源限制条件下选择能使健康效益最大化的组合。世界卫生组织关于广义CEA的指南建议将CEA应用于广泛的干预措施，以便在不存在各种高度本地化决策限制的情况下，提供关于不同干预措施相对成本和健康效益的一般信息。这种通用方法将有助于判断干预措施是具有高成本效益、高成本无效益，还是介于两者之间。广义CEA要求根据相关干预措施空集的反事实情况，即疾病的自然史，对一组干预措施进行评估。这种与任何特定决策者无关的相对成本效益的一般认识，可作为评估在各种环境中提高分配效率方向的有用参考点。所提出的框架能够识别当前的分配无效率以及新干预措施带来的机会。
