Subramanian Sujha, Ekwueme Donatus U, Gardner James G, Bapat Bela, Kramer Caren
RTI International 1440 Main Street-Suite 310 Waltham, MA 02451-1623, USA.
Eval Program Plann. 2008 May;31(2):136-44. doi: 10.1016/j.evalprogplan.2008.02.002. Epub 2008 Feb 15.
Performing economic evaluations of established health care programs is essential to identify and control for underlying program-level variations and to make valid comparisons. At a time when the need for such evaluations is growing, health care professionals have limited information on the methodological challenges of performing these evaluations. In this study, we used the National Breast and Cervical Cancer Early Detection Program to illustrate these potential underlying variations. We performed site visits to four grantees and collected activity-based cost data from nine additional representative programs. We identified five specific types of cost factors that should be considered when evaluating and comparing health care programs: clinical services, service mix, in-kind contributions, indirect costs, and year-to-year expenditures of specific activities. A key lesson is that case studies and pilot testing should be performed before initiating cost analysis to identify underlying variation and to test appropriate methods to adequately control for these differences.
对既定的医疗保健项目进行经济评估，对于识别和控制潜在的项目层面差异以及进行有效的比较至关重要。在对这类评估的需求不断增长的当下，医疗保健专业人员在进行这些评估所面临的方法学挑战方面掌握的信息有限。在本研究中，我们利用国家乳腺癌和宫颈癌早期检测项目来说明这些潜在的基础差异。我们对四个受资助方进行了实地考察，并从另外九个具有代表性的项目中收集了基于活动的成本数据。我们确定了在评估和比较医疗保健项目时应考虑的五种特定类型的成本因素：临床服务、服务组合、实物捐助、间接成本以及特定活动的逐年支出。一个关键的经验教训是，在启动成本分析之前应进行案例研究和试点测试，以识别潜在差异并测试适当的方法来充分控制这些差异。
