Shibuya K, Kunii O
Department of Hygiene and Public Health, Teikyo University of School of Medicine.
Nihon Koshu Eisei Zasshi. 2000 Dec;47(12):1018-28.
Cost-effectiveness analysis is a tool to help inform the decision maker of efficient allocation of scarce health care resources and its application has increased in developing countries during the past decade. There are, however, a variety of different approaches used to calculate cost-effectiveness ratios, given the range and the controversies surrounding the use of some components of total cost, depending on the constraints faced by various decision-making bodies. This study is an investigation of cost-effectiveness of both currently delivered and prospective health interventions in Mauritius to set priorities and assess allocative efficiency by taking into account such constraints.
Resource use and unit cost data were collected from the representative health facilities and the Ministry of Health to estimate costs of each health intervention per person. Effectiveness of each intervention was estimated from the results of the national burden of disease study and the efficacy database compiled for this exercise. Several types of cost-effectiveness were calculated for each intervention according to its characteristics and the constraints imposed by the existing infrastructures and other health interventions.
Cost-effectiveness ratios with and without the decision maker's constraints differed significantly. Infrastructure-constrained average cost-effectiveness of thirteen currently delivered and twenty one prospective interventions ranged from $127 to $92,949 and from $77 to $66,302 per DALY averted, respectively. Incremental cost-effectiveness of the prospective interventions was from $83 to $70,553. Among the currently delivered interventions, those for perinatal disorders, mental illness, and ischemic heart disease were particularly less cost-effective than the prospective interventions. Sensitivity analysis of both effectiveness and discount rates did not change the cost-effectiveness ranking significantly.
The present study showed that cost-effectiveness ratios differ significantly depending on the decision maker's constraints and that an interpretation of each cost-effectiveness study should be made with great caution when implementing its results in practice. Both average cost-effectiveness of the currently delivered interventions and incremental cost-effectiveness of the prospective interventions suggest that there is an allocative inefficiency among the currently delivered health interventions in Mauritius and a possibility of enhancing allocative efficiency through introducing alternative interventions.
成本效益分析是一种帮助决策者了解稀缺医疗资源有效配置的工具，在过去十年中，其在发展中国家的应用有所增加。然而，由于总成本某些组成部分的使用范围和争议，以及各决策机构面临的限制，用于计算成本效益比率的方法多种多样。本研究旨在调查毛里求斯当前实施的和未来的卫生干预措施的成本效益，通过考虑此类限制来确定优先事项并评估配置效率。
从具有代表性的卫生设施和卫生部收集资源使用和单位成本数据，以估算每人每项卫生干预措施的成本。每项干预措施的有效性根据国家疾病负担研究结果和为此项工作编制的疗效数据库进行估算。根据每项干预措施的特点以及现有基础设施和其他卫生干预措施所施加的限制，计算了几种类型的成本效益。
考虑决策者限制和不考虑决策者限制的成本效益比率存在显著差异。受基础设施限制的13项当前实施的干预措施和21项未来干预措施的平均成本效益分别为每避免一个伤残调整生命年127美元至92,949美元和77美元至66,302美元。未来干预措施的增量成本效益为83美元至70,553美元。在当前实施的干预措施中，围产期疾病、精神疾病和缺血性心脏病的干预措施的成本效益尤其低于未来干预措施。有效性和贴现率的敏感性分析并未显著改变成本效益排名。
本研究表明，成本效益比率因决策者的限制而有显著差异，在实际应用成本效益研究结果时，应极其谨慎地对每项成本效益研究进行解读。当前实施的干预措施的平均成本效益和未来干预措施的增量成本效益均表明，毛里求斯当前实施的卫生干预措施存在配置效率低下的问题，通过引入替代干预措施有可能提高配置效率。
