Simoens Steven
Research Centre for Pharmaceutical Care and Pharmaco-economics, Katholieke Universiteit Leuven Leuven, Belgium.
Front Pharmacol. 2010 Sep 7;1:115. doi: 10.3389/fphar.2010.00115. eCollection 2010.
This study aims to discuss approaches to assessing the value of medicines. Economic evaluation assesses value by means of the incremental cost-effectiveness ratio (ICER). Health is maximized by selecting medicines with increasing ICERs until the budget is exhausted. The budget size determines the value of the threshold ICER and vice versa. Alternatively, the threshold value can be inferred from pricing/reimbursement decisions, although such values vary between countries. Threshold values derived from the value-of-life literature depend on the technique used. The World Health Organization has proposed a threshold value tied to the national GDP. As decision makers may wish to consider multiple criteria, variable threshold values and weighted ICERs have been suggested. Other approaches (i.e., replacement approach, program budgeting and marginal analysis) have focused on improving resource allocation, rather than maximizing health subject to a budget constraint. Alternatively, the generalized optimization framework and multi-criteria decision analysis make it possible to consider other criteria in addition to value.
本研究旨在探讨评估药品价值的方法。经济评估通过增量成本效益比（ICER）来评估价值。通过选择ICER不断增加的药品，直至预算耗尽，从而实现健康最大化。预算规模决定了阈值ICER的价值，反之亦然。另外，阈值也可以从定价/报销决策中推断得出，不过各国的此类值有所不同。从生命价值文献中得出的阈值取决于所使用的技术。世界卫生组织提出了一个与国家GDP挂钩的阈值。由于决策者可能希望考虑多个标准，因此有人建议采用可变阈值和加权ICER。其他方法（即替代方法、项目预算编制和边际分析）侧重于改善资源分配，而不是在预算限制下实现健康最大化。另外，广义优化框架和多标准决策分析使得除了价值之外还能够考虑其他标准。
