Birch Stephen, Gafni Amiram
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Ontario, Canada L8N 3Z5.
J Health Serv Res Policy. 2006 Jan;11(1):46-51. doi: 10.1258/135581906775094235.
It has been suggested that scepticism among decision-makers about using cost-effectiveness analysis (CEA) is caused in part by the low level of the cost-effectiveness "thresholds" in the economic evaluation literature. This has led Ubel and colleagues to call for higher threshold values of US$200,000 or more per quality-adjusted life-year. We show that these arguments fail to identify the objective of CEA and hence do not consider whether or how the threshold relates to this objective. We show that incremental cost-effectiveness ratios (ICERs) cannot be used to identify an efficient use of resources--the "biggest bang for the bucks"--allocated to health care. On the contrary, the practical consequence of using the ICER approach is shown to be an increase in health care expenditures, or "bigger bucks for making a bang", without any evidence of the bang being bigger (i.e. that this leads to an increase in benefits to the population). We present an alternative approach that provides an unambiguous method of determining whether a new intervention leads to an increase in health gains from whatever resources are to be made available to health care decision-makers.
有人认为，决策者对使用成本效益分析（CEA）持怀疑态度，部分原因是经济评估文献中成本效益“阈值”水平较低。这导致乌贝尔及其同事呼吁将阈值提高到每质量调整生命年20万美元或更高。我们表明，这些论点未能明确CEA的目标，因此没有考虑阈值是否以及如何与该目标相关。我们表明，增量成本效益比（ICER）不能用于确定分配给医疗保健的资源的有效利用方式——“资金的最大效益”。相反，使用ICER方法的实际后果是医疗保健支出增加，即“为了产生效益而投入更多资金”，但没有任何证据表明效益会更大（即这会导致人群受益增加）。我们提出了一种替代方法，该方法提供了一种明确的方法，以确定新的干预措施是否会从提供给医疗保健决策者的任何资源中带来健康收益的增加。
