Sendi Pedram, Al Maiwenn J
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Soc Sci Med. 2003 Sep;57(6):969-74. doi: 10.1016/s0277-9536(02)00477-x.
The classical decision rule of cost-effectiveness analysis uses a threshold cost-effectiveness ratio as a cut-off point for resources allocation. One assumption of this decision rule is complete divisibility of health care programs. In this article, we argue that health care programs cannot be completely divisible since individuals are not divisible. Consequently, instead of a linear programming approach, an integer programming approach to budget allocation is suggested. The integer programming framework can be extended to include uncertainty in the analysis. An objective function (expected aggregate effects) is maximised subject to the constraint that the probability of exceeding the budget is limited to an arbitrary level (e.g., 0.05). In case the budget is exceeded, the objective function is penalised in order to account for the opportunity costs of the additional resource requirements.
成本效益分析的经典决策规则使用阈值成本效益比作为资源分配的临界点。该决策规则的一个假设是医疗保健项目具有完全可分性。在本文中，我们认为医疗保健项目不能完全可分，因为个体是不可分割的。因此，建议采用整数规划方法进行预算分配，而不是线性规划方法。整数规划框架可以扩展到在分析中纳入不确定性。目标函数（预期总效应）在预算超支概率限制在任意水平（如0.05）的约束下最大化。如果超出预算，目标函数将受到惩罚，以考虑额外资源需求的机会成本。
