Bégaud Bernard, Bergman Ulf, Eichler Hans-Georg, Leufkens Hubert G M, Meier Peter J
Départment de Pharmacologie, Université Victor Segalen Bordeaux 2, Hôpital Pellegrin, F33076 Bordeaux cedex, France.
Br J Clin Pharmacol. 2002 Nov;54(5):528-34. doi: 10.1046/j.1365-2125.2002.01690.x.
In many countries, governments and third parties find themselves paying for (reimbursing) unproven, inadequate products limiting their ability to invest in therapies with evidence of relevant patient benefit. We examined how three characteristics, level of therapeutic evidence, susceptibility of inappropriate prescribing, and intercountry variation can be used to identify inefficiencies in pharmaceutical reimbursement among four European Union countries, Austria, Belgium, the Netherlands and Sweden.
Specific classes of medicines were chosen to provide useful examples of how healthcare resources could be reallocated. A high level of therapeutic evidence was defined as a substantial body of evidence in at least one indication with clear-cut support of relevant patient benefit. The susceptibility of inappropriate prescribing was defined as the likelihood of prescribing a drug outside the scenario for which clear-cut evidence (if any) has been documented to produce relevant benefit for the patient. The intercountry variation represents the variation in utilization of reimbursed drugs across the four countries.
The combination of these characteristics provides a useful tool for assessing appropriate reimbursement decisions. It would be beneficial to healthcare payers as well as patients to move resources from products that have a low level of therapeutic evidence and a high susceptibility of inappropriate prescribing to products with a high level of therapeutic evidence and low susceptibility of inappropriate prescribing, and to use intercountry variation as a signal of drug classes that should be subject to further scrutiny.
A method is presented to help policy-makers identify inefficiencies in the spending of limited health care resources, and to reallocate resources to products that have been shown to improve patient care through evidence-based medicine.
在许多国家，政府和第三方发现自己在为未经证实、效果不佳的产品付费（报销），这限制了它们投资于有证据表明能给患者带来相关益处的治疗方法的能力。我们研究了治疗证据水平、不适当处方的易感性以及国家间差异这三个特征如何用于识别奥地利、比利时、荷兰和瑞典这四个欧盟国家在药品报销方面的低效率情况。
选择特定类别的药物，以提供关于如何重新分配医疗资源的有用示例。高水平的治疗证据被定义为在至少一种适应症中有大量证据明确支持对患者有相关益处。不适当处方的易感性被定义为在没有明确证据（如果有的话）表明能给患者带来相关益处的情况下开具某种药物处方的可能性。国家间差异代表这四个国家报销药物使用情况的差异。
这些特征的组合为评估适当的报销决策提供了一个有用的工具。将资源从治疗证据水平低且不适当处方易感性高的产品转移到治疗证据水平高且不适当处方易感性低的产品，并将国家间差异作为应进一步审查的药物类别的信号，这对医疗支付方和患者都有益。
提出了一种方法，以帮助政策制定者识别有限医疗资源支出中的低效率情况，并将资源重新分配到已证明通过循证医学可改善患者护理的产品上。
