Department of Health Services, University of Washington, Seattle, 1959 NE Pacific St, Box 357660, Seattle, WA 98195-7660, USA.
J Health Econ. 2011 May;30(3):549-59. doi: 10.1016/j.jhealeco.2011.03.004. Epub 2011 Apr 23.
The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset.
美国希望利用来自比较效果研究（CER）的信息来减少浪费和控制成本，而不会引入正式的配给机制，也不会损害患者或医生在治疗选择方面的自主权。有了如此雄心勃勃的目标，CER 中使用的传统研究设计和分析方法的组合可能会导致令人失望的结果。在本文中，我研究了比较效果信息的替代制度如何帮助塑造人群中的边际收益（需求）曲线，以及这种感知到的需求曲线如何影响个体患者层面的决策和社会层面的福利。我强调需要个性化比较效果研究，以生成治疗方法的真实（规范）需求曲线。我讨论了指导此类研究设计的方法原则。我使用药物滥用治疗对犯罪的比较效果的例子，使用新颖的计量经济学方法从现有数据集中提取个性化信息。
