Boos Norbert
Centre for Spinal Surgery, University of Zurich, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
Eur Spine J. 2009 Aug;18 Suppl 3(Suppl 3):338-47. doi: 10.1007/s00586-009-0939-3. Epub 2009 Apr 1.
Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.
在过去二十年中，医疗保健支出大幅增加，这促使人们迫切需要对医疗保健进行经济评估。从历史上看，医疗保健领域的经济评估采用了四种方法：（1）人力资本法（HCA），（2）成本效益分析（CEA），（3）成本效用分析（CUA）和（4）成本效益分析（CBA）。由于方法上的缺陷，HCA不被推荐，而CEA和CUA在医疗保健中经常被使用。在CEA中，成本以货币形式衡量，健康效果以非货币单位衡量，例如成功治疗的患者数量。为了开发一种综合考虑对生活质量和数量影响的有效性衡量方法，引入了所谓的质量调整生命年（QUALYs）。在成本效益分析（CBA）中，使用条件价值调查通过应用支付意愿方法来获取消费者对项目效益的货币估值。CBA的一个显著特点是成本和效益以相同的价值单位表示，即货币。直到最近，经济评估才开始探索各种脊柱干预措施，特别是非常昂贵的融合手术。虽然大多数研究使用CEA或CUA方法，但CBA仍然很少见。大多数研究未能表明复杂的脊柱干预措施比传统治疗更具成本效益。尽管大多数脊柱手术缺乏治疗效果或成本效益，但脊柱植入市场仍在迅速增长，这表明市场存在缺陷和信息不对称。只有当医生开始关注医疗保健质量的提高时，才有望发生变化，这已由结果研究以及成本效益和净效益的经济评估所证明。
