Cohen Joshua Parsons, Stolk Elly, Niezen Maartje
Tufts University.
J Health Polit Policy Law. 2008 Apr;33(2):225-47. doi: 10.1215/03616878-2007-054.
There are three known criteria that underlie drug reimbursement decisions: therapeutic value, cost-effectiveness, and burden of disease. However, evidence from recent reimbursement decisions in several jurisdictions points to residual, unexplained variables, among which is budget impact. Budget impact refers to the total costs that drug reimbursement and use entail with respect to one part of the health care system, pharmaceutical care, or to the entire health care system, taking into account the possible reallocation of resources across budgets or sectors of the health care system. The economic and equity rationale for carrying out budget impact analyses is opportunity cost, or benefits forgone, measured in terms of utility or equitable distribution, by using resources in one way rather than another. In other words, by choosing to draw down the budget in one way, decision makers forgo other opportunities to use the same resources. Under a set of unrealistic assumptions, cost-effectiveness analysis accounts for opportunity cost while conveying to the decision maker the price of maximizing health gains, subject to a budget or resource constraint. However, the underlying assumptions are implausible, particularly in the context of pharmaceutical care. Moreover, budget impact analysis is more useful to the decision maker than cost-effectiveness analysis if the objective is not to maximize health gains subject to a budget or resource constraint, but to reduce variance in health gains. With respect to equitable distribution, budget impact analyses lay bare the individuals or groups who lose out - those who bear the opportunity cost of spending resources in accordance with one decision rule rather than another.
治疗价值、成本效益和疾病负担。然而，几个司法管辖区近期报销决策的证据表明存在一些残留的、无法解释的变量，其中包括预算影响。预算影响是指药物报销和使用给医疗保健系统的一个部分（药学服务）或整个医疗保健系统带来的总成本，同时考虑到医疗保健系统各预算或部门之间可能的资源重新分配。进行预算影响分析的经济和公平理由是机会成本，即通过以一种方式而非另一种方式使用资源，以效用或公平分配来衡量的放弃的利益。换句话说，通过选择以一种方式动用预算，决策者放弃了使用相同资源的其他机会。在一组不现实的假设下，成本效益分析在考虑预算或资源限制的情况下，在向决策者传达最大化健康收益的代价的同时，也考虑了机会成本。然而，这些基本假设是不合理的，特别是在药学服务的背景下。此外，如果目标不是在预算或资源限制下最大化健康收益，而是减少健康收益的差异，那么预算影响分析对决策者比成本效益分析更有用。关于公平分配，预算影响分析揭示了那些受到损失的个人或群体——那些承担按照一种决策规则而非另一种决策规则使用资源的机会成本的人。
