Brüggenjürgen B
Steinbeis-Hochschule-Berlin, Gürtelstr. 29A/30, 10247 Berlin.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Sep;53(9):890-5. doi: 10.1007/s00103-010-1118-8.
Decision-making in healthcare is a priority-setting process. Tools used in health economic evaluation support decision-making by outlining complex interdependences, simulating short- and long-term consequences, and quantifying formal comparisons of health technologies. Key elements in health economic evaluations are patient-relevant outcomes and cost parameters. Costing of healthcare services is demanding and reflects only an approximation to reality, particularly in Germany, as the reimbursement schemes neither fully provide all details nor the different costing perspectives. Hence, in order to obtain uniform and cross-indication applicable cost parameters, a German standard cost dataset is necessary. In addition, patient-relevant and indication-specific sets of outcomes parameters should be agreed upon in order to also enable a reliable clinical product development. Economic aspects could be applied in a two-step decision-making approach, where initially the anticipated indication-specific technical efficiency level in terms of cost per adjusted life years would be assessed from a health system perspective. The second step would employ prioritization based on indication-relevant outcomes and ranking criteria in the individual patient decision situation. Health economic evaluations are relevant tools to support prioritization of health technologies, both on an individual as well as public health level.
医疗保健中的决策是一个确定优先事项的过程。卫生经济评估中使用的工具通过概述复杂的相互依存关系、模拟短期和长期后果以及量化卫生技术的正式比较来支持决策。卫生经济评估的关键要素是与患者相关的结果和成本参数。医疗服务的成本核算要求很高，而且只是对现实的一种近似反映，在德国尤其如此，因为报销方案既没有完全提供所有细节，也没有涵盖不同的成本核算视角。因此，为了获得统一且适用于不同适应症的成本参数，德国标准成本数据集是必要的。此外，还应商定与患者相关且针对特定适应症的结果参数集，以便也能实现可靠的临床产品开发。经济方面可应用于两步决策方法，首先从卫生系统的角度评估预期的特定适应症技术效率水平，即每调整生命年的成本。第二步将根据个体患者决策情况下与适应症相关的结果和排名标准进行优先级排序。卫生经济评估是支持在个体以及公共卫生层面确定卫生技术优先顺序的相关工具。
