Bridges John F P, Cohen Joshua P, Grist Peter G, Mühlbacher Axel C
Johns Hopkins University, Baltimore, MD, USA.
Adv Health Econ Health Serv Res. 2010;22:29-50. doi: 10.1108/s0731-2199(2010)0000022005.
Although the US has lagged behind international developments in health technology assessment (HTA), renewed interest in HTA in the US has been fueled by the appropriation of $1.1 billion comparative effectiveness research (CER) in 2009 and the debate over health care reform.
To inform CER practices in the US, we present case studies of HTA from England/Wales and Germany: contrasting methods; relevance to the US; and impact on innovation.
The National Institute of Health and Clinical Excellence (NICE) was established in 1999 to inform trusts within the National Health Service of England and Wales. It uses cost-effectiveness analysis to guide the allocation resource across preventative and curative interventions. In Germany, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) was established in 2004 to inform reimbursement and pricing policies for the statutory sickness funds set by the Gemeinsamer Bundesaursschuss (G-BA). IQWiG evaluates competing technologies within specific therapeutic areas, placing more weight on clinical evidence and the relative efficiency of competing therapies.
Although having deep political and cultural antecedents, differences between NICE and IQWiG can be explained by perspective: the former guiding resource allocation across an entire system (macro-evaluation), the latter focusing on efficiency within the bounds of a particular therapeutic area (micro-evaluation). Given the decentralized nature of the US health care system, and the relative powers of different medical specialties, the IQWiG model presents a more suitable case study to guided CER efforts in the US.
尽管美国在卫生技术评估（HTA）方面落后于国际发展，但2009年拨款11亿美元用于比较效果研究（CER）以及关于医疗改革的辩论激发了美国对HTA的新兴趣。
为了为美国的CER实践提供参考，我们展示了来自英格兰/威尔士和德国的HTA案例研究：对比方法；与美国的相关性；以及对创新的影响。
英国国家卫生与临床优化研究所（NICE）成立于1999年，为英格兰和威尔士国民医疗服务体系内的信托机构提供信息。它使用成本效益分析来指导预防性和治疗性干预措施的资源分配。在德国，医疗卫生质量与效率研究所（IQWiG）成立于2004年，为共同联邦委员会（G-BA）设定的法定疾病基金的报销和定价政策提供信息。IQWiG在特定治疗领域评估竞争性技术，更重视临床证据和竞争性疗法的相对效率。
尽管NICE和IQWiG之间存在深刻的政治和文化渊源，但它们之间的差异可以从视角上进行解释：前者指导整个系统的资源分配（宏观评估），后者关注特定治疗领域范围内的效率（微观评估）。鉴于美国医疗保健系统的分散性质以及不同医学专业的相对权力，IQWiG模式为指导美国的CER努力提供了更合适的案例研究。
