Porzsolt Franz
Clinical Economics, University of Ulm, Ulm, Germany.
Recent Results Cancer Res. 2011;188:11-20. doi: 10.1007/978-3-642-10858-7_2.
It is mandatory to compare cost and consequences of healthcare services if public support is requested. This request will apply to all healthcare services including prevention. As the demand for health care will always exceed the available resources, methods that make it possible to select the "best" programs for implementation have to be developed. The selection of the "best" programs is not easy because there exist so far no generally accepted quality criteria that can be used to identify the "best" prevention programs.Based on a model on structural and functional properties of a disease, it is concluded that the traditional outcomes of treatment and prevention may be useful for the evaluation of tertiary prevention programs, but not of secondary prevention programs. Neither the traditional endpoints of treatment studies nor traditional surrogate parameters are useful for the evaluation of secondary prevention programs.Using the assumptions of the model and a list of available data in secondary prevention programs we recommend to assess five indicators for description of the value of a secondary prevention program: quality of life, surrogates for life expectancy, the perspective of the assessor, the conditions of assessment, and finally the payment. As each of these five items offers two possible values prevention programs may be classified into 32 different groups.
如果需要公众支持，那么比较医疗服务的成本和后果是必须的。这个要求将适用于所有医疗服务，包括预防。由于医疗保健需求总是会超过可用资源，因此必须开发能够选择“最佳”项目进行实施的方法。选择“最佳”项目并不容易，因为目前还没有普遍接受的质量标准可用于识别“最佳”预防项目。基于疾病的结构和功能特性模型，得出结论：传统的治疗和预防结果可能有助于评估三级预防项目，但对二级预防项目则不然。治疗研究的传统终点和传统替代参数都无助于评估二级预防项目。利用该模型的假设和二级预防项目中的可用数据列表，我们建议评估五个指标来描述二级预防项目的价值：生活质量、预期寿命替代指标、评估者的视角、评估条件，最后是支付情况。由于这五个项目中的每一个都有两种可能的值，预防项目可以分为32个不同的组。
