卫生项目的组合评估：对森迪等人的回应

Portfolio evaluation of health programs: a reply to Sendi et al.

作者信息

Bridges John F P, Terris Darcey D

机构信息

Department of Epidemiology and Biostatistics, Health Services Research Division, Case Western Reserve University, School of Medicine, Room WG57, 10900 Euclid Avenue, Cleveland, Ohio 44106-4945, USA.

出版信息

Soc Sci Med. 2004 May;58(10):1849-51. doi: 10.1016/j.socscimed.2004.01.002.

DOI:10.1016/j.socscimed.2004.01.002

PMID:15020002

Abstract

Sendi et al. (Soc. Sci. Med. 57 (2003) 2207) extend previous research on cost-effectiveness analysis to the evaluation of a portfolio of interventions with risky outcomes using a "second best" approach that can identify improvements in efficiency in the allocation of resources. This method, however, cannot be used to directly identify the optimal solution to the resource allocation problem. Theoretically, a stricter adherence to the foundations of portfolio theory would permit direct optimization in portfolio selection, however, when we include uncertainty in our analysis in addition to the traditional concept of risk (which is often mislabelled uncertainty) complexities are introduced that create significant hurdles in the development of practical applications of portfolio theory for health care policy decision making.

摘要

森迪等人（《社会科学与医学》，57卷，2003年，第2207页）将先前关于成本效益分析的研究扩展到使用“次优”方法评估具有风险结果的一系列干预措施，该方法可以识别资源分配效率的提高。然而，这种方法不能直接用于确定资源分配问题的最优解决方案。从理论上讲，更严格地遵循投资组合理论的基础将允许在投资组合选择中进行直接优化，但是，当我们在分析中除了纳入传统的风险概念（往往被错误地标记为不确定性）之外还纳入不确定性时，就会引入复杂性，这给投资组合理论在医疗保健政策决策中的实际应用发展带来了重大障碍。