Appel L J, Steinberg E P, Powe N R, Anderson G F, Dwyer S A, Faden R R
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Med Care. 1990 Apr;28(4):324-37. doi: 10.1097/00005650-199004000-00004.
Decisions regarding the use of and reimbursement for new medical technologies frequently involve complex cost-quality trade-offs. Among physicians, hospital administrators, and insurers, interindividual variation in the value of benefits attributable to these technologies often leads to conflicting opinions about their appropriate use. Although society now encourages patient involvement in such decisions, few methods for obtaining patient valuations have been developed and systematically applied. In order to assess patient valuations of a particular new technology, low osmolality contrast media (LOM), a survey of 100 outpatients was conducted. Participants were asked about their willingness to pay (WTP) for the benefits of this expensive medical technology. Of the 95 subjects who completed the study questionnaire, a majority were unwilling to pay the minimum extra per procedure cost of LOM ($50) in return for a reduced risk of minor side effects alone (pain, nausea, hives, and flushing). For a reduced risk of both major side effects (death, renal insufficiency, severe allergic reaction, and cardiac arrhythmia) and minor side effects, the median WTP was $50; patient income and education were directly associated with WTP $50 or more. We conclude that similar WTP surveys may be helpful in addressing other difficult cost-quality issues.
关于新医疗技术的使用和报销的决策常常涉及复杂的成本-质量权衡。在医生、医院管理人员和保险公司之间，这些技术所带来的益处的价值在个体间存在差异，这常常导致对于其恰当使用产生相互冲突的意见。尽管社会现在鼓励患者参与此类决策，但很少有获取患者估值的方法得到开发并被系统应用。为了评估患者对一种特定新技术——低渗造影剂（LOM）的估值，我们对100名门诊患者进行了一项调查。参与者被问及他们为这种昂贵医疗技术的益处愿意支付的费用（WTP）。在完成研究问卷的95名受试者中，大多数人不愿意仅为了降低轻微副作用（疼痛、恶心、荨麻疹和潮红）的风险而支付LOM每次检查的最低额外费用（50美元）。对于同时降低严重副作用（死亡、肾功能不全、严重过敏反应和心律失常）和轻微副作用的风险，愿意支付的费用中位数为50美元；患者的收入和教育程度与愿意支付50美元或更多费用直接相关。我们得出结论，类似的愿意支付费用调查可能有助于解决其他困难的成本-质量问题。
