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卫生技术优先排序:优先考虑新技术的标准有哪些,以及它们的相对权重是什么?

Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights?

机构信息

The Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.

出版信息

Health Policy. 2011 Oct;102(2-3):126-35. doi: 10.1016/j.healthpol.2010.10.012. Epub 2010 Nov 11.

DOI:10.1016/j.healthpol.2010.10.012
PMID:21071107
Abstract

OBJECTIVES

To review the criteria and 'other' considerations used internationally for prioritizing new health technologies, and to demonstrate a conjoint-analysis methodology (also known as discrete choice experiments) for deriving relative weights for the criteria.

METHODS

We searched the literature for criteria and other considerations for prioritizing new technologies. A convenience sample of 74 respondents completed a conjoint-analysis survey involving criteria related to technologies' 'benefits'.

RESULTS

Encompassing 11 countries and the US state of Oregon, we were able to distinguish three main groups of criteria: (a) Need, appropriateness and clinical benefits; (b) Efficiency (including cost-effectiveness); and (c) Equality, solidarity and other ethical or social values. For several countries, the quality of the clinical and economic evidence and factors related to strategic issues and procedural justice respectively are also considered. The criteria and their weights from the conjoint-analysis survey are: 'Lives saved'=0.343, 'Life-prolongation benefits'=0.243, 'Quality-of-life gains'=0.217, a criterion representing the availability of alternative treatments=0.107, and 'Other important social/ethical benefits'=0.087.

CONCLUSIONS

The criteria represent a pluralistic combination of needs-based, maximizing and egalitarian principles, and we demonstrated a methodology for deriving the weights for criteria related to technologies' 'benefits'.

摘要

目的

回顾国际上用于优先考虑新医疗技术的标准和“其他”考虑因素,并展示一种联合分析方法(也称为离散选择实验),用于为标准推导相对权重。

方法

我们搜索了文献中有关新技术优先排序的标准和其他考虑因素。74 名受访者完成了一项联合分析调查,该调查涉及与技术“效益”相关的标准。

结果

我们涵盖了 11 个国家和美国俄勒冈州,能够区分出三类主要的标准:(a)需求、适当性和临床效益;(b)效率(包括成本效益);(c)平等、团结和其他伦理或社会价值观。对于几个国家,还考虑了临床和经济证据的质量以及与战略问题和程序正义相关的因素。联合分析调查的标准及其权重是:“拯救生命”=0.343,“延长生命效益”=0.243,“生活质量收益”=0.217,代表替代治疗方法可用性的标准=0.107,以及“其他重要的社会/伦理效益”=0.087。

结论

这些标准代表了基于需求、最大化和平等主义原则的多元化组合,我们展示了一种用于推导与技术“效益”相关标准权重的方法。

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