Koopmanschap Marc A, van Exel Job N A, van den Berg Bernard, Brouwer Werner B F
Department of Health Policy and Management (iBMG), Erasmus MC Rotterdam, Rotterdam, the Netherlands.
Pharmacoeconomics. 2008;26(4):269-80. doi: 10.2165/00019053-200826040-00001.
This paper compares several applied valuation methods for including informal care in economic evaluations of healthcare programmes: the proxy good method; the opportunity cost method; the contingent valuation method (CVM); conjoint measurement (CM); and valuation of health effects in terms of health-related quality of life (HR-QOL) and well-being. The comparison focuses on three questions: what outcome measures are available for including informal care in economic evaluations of healthcare programmes; whether these measures are compatible with the common types of economic evaluation; and, when applying these measures, whether all relevant aspects of informal care are incorporated. All types of economic evaluation can incorporate a monetary value of informal care (using the opportunity cost method, the proxy good method, CVM and CM) on the cost side of an analysis, but only when the relevant aspects of time costs have been valued. On the effect side of a cost-effectiveness or cost-utility analysis, the health effects (for the patient and/or caregiver) measured in natural units or QALYs can be combined with cost estimates based on the opportunity cost method or the proxy good method. One should be careful when incorporating CVM and CM in cost-minimization, cost-effectiveness and cost-utility analyses, as the health effects of patients receiving informal care and the carers themselves may also have been valued separately. One should determine whether the caregiver valuation exercise allows combination with other valuation techniques. In cost-benefit analyses, CVM and CM appear to be the best tools for the valuation of informal care. When researchers decide to use the well-being method, we recommend applying it in a cost-benefit analysis framework. This method values overall QOL (happiness); hence it is broader than just HR-QOL, which complicates inclusion in traditional health economic evaluations that normally define outcomes more narrowly. Using broader, non-monetary valuation techniques, such as the CarerQol instrument, requires a broader evaluation framework than cost-effectiveness/cost-utility analysis, such as cost-consequence or multi-criteria analysis.
替代商品法；机会成本法；条件估值法（CVM）；联合测量法（CM）；以及根据与健康相关的生活质量（HR-QOL）和幸福感对健康影响进行估值。比较聚焦于三个问题：在医疗保健项目的经济评估中纳入非正式护理可采用哪些结果指标；这些指标是否与常见的经济评估类型兼容；以及在应用这些指标时，非正式护理的所有相关方面是否都已纳入。所有类型的经济评估都可以在分析的成本方面纳入非正式护理的货币价值（使用机会成本法、替代商品法、CVM和CM），但前提是时间成本的相关方面已经得到估值。在成本效益或成本效用分析的效果方面，以自然单位或质量调整生命年（QALYs）衡量的健康影响（针对患者和/或护理者）可以与基于机会成本法或替代商品法的成本估计相结合。在将CVM和CM纳入成本最小化、成本效益和成本效用分析时应谨慎，因为接受非正式护理的患者及其护理者本身的健康影响可能也已分别进行了估值。应确定护理者估值活动是否允许与其他估值技术相结合。在成本效益分析中，CVM和CM似乎是评估非正式护理的最佳工具。当研究人员决定使用幸福感方法时，我们建议在成本效益分析框架中应用它。这种方法对总体生活质量（幸福感）进行估值；因此它比仅HR-QOL更宽泛，这使得将其纳入通常对结果定义更狭窄的传统健康经济评估变得复杂。使用更宽泛的非货币估值技术，如护理者生活质量量表（CarerQol）工具，需要一个比成本效益/成本效用分析更宽泛的评估框架，如成本后果或多标准分析。
