University of California, San Francisco, USA.
Oncologist. 2010;15 Suppl 1:73-9. doi: 10.1634/theoncologist.2010-S1-73.
The U.S. spends far more per person than any other country in the world in treating cancer, without demonstrably superior results. Though the pursuit and pace of innovation in oncology are perhaps unmatched and promise great benefit for cancer patients, this explosion of innovation has been accompanied by dramatic increases in cost, often without significant increases in patient survival. These trends have led to a growing interest in addressing value--understood as treatment benefits or quality weighed against economic cost--in cancer care. In February 2009, the Institute of Medicine convened a group of experts with diverse perspectives, including those of clinical oncology, patient advocacy, the insurance industry, pharmaceutical manufacturing, health economics, and bioethics, to identify challenges to value in cancer care, suggest potential solutions, and discuss what value entails in oncology. This article presents many of the ideas that emerged from this symposium, including ways to correct misaligned economic incentives, improve clinical communication, and generate evidence to promote value in cancer care.
美国在治疗癌症方面的人均支出远远超过世界上任何其他国家，但并未取得明显更好的效果。尽管肿瘤学领域的追求和创新步伐或许无与伦比，并有望为癌症患者带来巨大的益处，但这种创新的爆发伴随着成本的急剧上升，而患者的生存率往往没有显著提高。这些趋势促使人们越来越关注癌症护理中的价值问题——将治疗效益或质量与经济成本进行权衡。2009 年 2 月，美国医学研究所召集了一组具有不同观点的专家，包括临床肿瘤学、患者权益倡导、保险行业、制药业、卫生经济学和生物伦理学等领域的专家，以确定癌症护理中存在的价值挑战，提出潜在的解决方案，并讨论肿瘤学中的价值所包含的内容。本文介绍了本次研讨会提出的许多观点，包括纠正经济激励措施错位、改善临床沟通以及生成证据以促进癌症护理中的价值等方法。
