Detsky A S, Naglie I G
Division of General Internal Medicine and Clinical Epidemiology, Toronto General Hospital, Ontario.
Ann Intern Med. 1990 Jul 15;113(2):147-54. doi: 10.7326/0003-4819-113-2-147.
Cost-effectiveness analysis can be used to help set priorities for funding health care programs. For each intervention, the costs and clinical outcomes associated with that strategy must be compared with an alternate strategy for treating the same patients. If an intervention results in improved outcomes but also costs more, the incremental cost per incremental unit of clinical outcome should be calculated. The incremental cost-effectiveness ratios for various programs can be ranked to set funding priorities. By using this list, the person responsible for allocating resources can maximize the net health benefit for a target population derived from a fixed budget. Clinicians may not share this objective because, individually, they are appropriately concerned solely with the effectiveness of a specific intervention for their patients and are not concerned with the benefit derived from spending those resources on other patients in the target population. In addition, allocation may be driven by distributional and political objectives. Nevertheless, cost-effectiveness analysis demonstrates the consequences of allocation decisions. Because clinicians should participate in policy making, they must understand d the role of this technique in setting funding priorities.
成本效益分析可用于帮助确定医疗保健项目的资金优先次序。对于每一种干预措施，必须将与该策略相关的成本和临床结果与治疗相同患者的替代策略进行比较。如果一种干预措施能改善结果但成本也更高，则应计算每增加一个临床结果单位的增量成本。可以对各种项目的增量成本效益比进行排序，以确定资金优先次序。通过使用这份清单，负责分配资源的人员可以使固定预算为目标人群带来的净健康效益最大化。临床医生可能不认同这一目标，因为就个人而言，他们只适当地关注特定干预措施对其患者的有效性，而不关心将这些资源用于目标人群中的其他患者所带来的益处。此外，资源分配可能受分配和政治目标的驱动。然而，成本效益分析表明了分配决策的后果。由于临床医生应该参与政策制定，他们必须了解这项技术在确定资金优先次序中的作用。
