Gandjour Afschin, Lauterbach Karl Wilhelm
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
J Health Econ. 2005 Jul;24(4):715-24. doi: 10.1016/j.jhealeco.2004.11.009. Epub 2005 Mar 20.
Published cost-effectiveness analyses may overstate the cost-effectiveness ratio of preventive care if they do not explicitly model the costs of the last year of life, which is postponed by prevention. To determine the degree of overestimation, the authors built a statistical model using Medicare expenditure data on survivors and decedents. The model shows that the cost-effectiveness ratio of prevention may decrease by up to US$ 11,000 per quality-adjusted life year saved when expenditure data on the last year life are used. The model is able to explain more than half of the median cost increase of published cost-effectiveness analyses on clinical preventive services.
如果已发表的成本效益分析没有明确模拟因预防而推迟的生命最后一年的成本，那么它们可能会高估预防保健的成本效益比。为了确定高估的程度，作者利用医疗保险关于幸存者和死者的支出数据构建了一个统计模型。该模型表明，当使用生命最后一年的支出数据时，预防的成本效益比可能会降至每获得一个质量调整生命年最多减少11,000美元。该模型能够解释已发表的临床预防服务成本效益分析中值成本增加的一半以上。
