van Baal Pieter H M, Feenstra Talitha L, Hoogenveen Rudolf T, de Wit G Ardine, Brouwer Werner B F
Centre for Prevention and Health Services Research (PZO), National Institute for Public Health and the Environment (RIVM), The Netherlands.
Health Econ. 2007 Apr;16(4):421-33. doi: 10.1002/hec.1181.
An important subject of debate in cost-utility analysis of health care programmes is whether to include costs of unrelated medical care in life years gained. The inclusion of such costs is likely to be of consequence in the case of primary prevention. This paper presents different strategies regarding the inclusion not only of the costs, but also of the health effects of unrelated medical care in economic evaluations. Four different cost-utility ratios are presented and related to the criterion of internal consistency. In addition, the possibility to relate the ratios to a well-posed decision problem is analysed. An example computes the different ratios for smoking cessation interventions in different age groups. Including health care costs of unrelated medical care in life years gained increases cost utility ratios, but excluding unrelated medical costs favours smoking cessation interventions targeted at older smokers over those at younger smokers. We conclude that for primary prevention only a cost utility ratio that includes both the costs and effects of unrelated medical care meets the criterion of internal consistency and is related to a meaningful decision problem. Therefore, this type of cost-utility ratio should be preferred even if the data requirements may be substantial.
医疗保健项目成本效用分析中一个重要的辩论主题是，在计算获得的生命年数时是否应计入无关医疗护理的成本。在一级预防的情况下，计入此类成本可能会产生影响。本文提出了不同的策略，不仅涉及成本的计入，还涉及无关医疗护理的健康影响在经济评估中的计入。文中给出了四种不同的成本效用比，并将其与内部一致性标准相关联。此外，还分析了将这些比率与一个恰当决策问题相关联的可能性。一个例子计算了不同年龄组戒烟干预措施的不同比率。在计算获得的生命年数时计入无关医疗护理的医疗保健成本会提高成本效用比，但排除无关医疗成本则更有利于针对老年吸烟者的戒烟干预措施，而不是针对年轻吸烟者的措施。我们得出结论，对于一级预防而言，只有一种既计入无关医疗护理的成本又计入其影响的成本效用比符合内部一致性标准，并且与一个有意义的决策问题相关。因此，即使数据要求可能很高，这种类型的成本效用比也应优先选用。
