Eichler Hans-Georg, Kong Sheldon X, Gerth William C, Mavros Panagiotis, Jönsson Bengt
Vienna Center for Pharmaceutical Policy, Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Value Health. 2004 Sep-Oct;7(5):518-28. doi: 10.1111/j.1524-4733.2004.75003.x.
An increasing number of health-care systems, both public and private, such as managed-care organizations, are adopting results from cost-effectiveness (CE) analysis as one of the measures to inform decisions on allocation of health-care resources. It is expected that thresholds for CE ratios may be established for the acceptance of reimbursement or formulary listing.
This paper provides an overview of the development of and debate on CE thresholds, reviews threshold figures (i.e., cost per unit of health gain) currently proposed for or applied to resource-allocation decisions, and explores how thresholds may emerge.
At the time of this review, there is no evidence from the literature that any health-care system has yet implemented explicit CE ratio thresholds. The fact that some government agencies have utilized results from CE analysis in pricing/reimbursement decisions allows for retrospective analysis of the consistency of these decisions. As CE analysis becomes more widely utilized in assisting health-care decision-making, this may cause decision-makers to become increasingly consistent.
When CE analysis is conducted, well-established methodology should be used and transparency should be ensured. CE thresholds are expected to emerge in many countries, driven by the need for transparent and consistent decision-making. Future thresholds will likely be higher in most high-income countries than currently cited rules of thumb.
越来越多的医疗保健系统，包括公共和私人的，如管理式医疗组织，正在采用成本效益（CE）分析的结果作为为医疗资源分配决策提供信息的措施之一。预计可能会为报销或列入药品目录设定CE比率阈值。
本文概述了CE阈值的发展及相关争论，回顾了目前为资源分配决策提议或应用的阈值数字（即每单位健康收益的成本），并探讨了阈值可能如何出现。
在本次综述时，文献中没有证据表明任何医疗保健系统已经实施了明确的CE比率阈值。一些政府机构在定价/报销决策中利用CE分析结果这一事实，使得可以对这些决策的一致性进行回顾性分析。随着CE分析在协助医疗保健决策中得到更广泛的应用，这可能会使决策者越来越趋于一致。
进行CE分析时，应使用成熟的方法并确保透明度。由于需要透明和一致的决策，预计CE阈值将在许多国家出现。在大多数高收入国家，未来的阈值可能会高于目前引用的经验法则。
