Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
Rheumatology (Oxford). 2012 Feb;51(2):210-5. doi: 10.1093/rheumatology/ker348.
Inflammatory rheumatic diseases are common. It is estimated that ∼2.1% of the population has an inflammatory rheumatic disease (Andrianakos A, Trontzas P, Christoyannis F et al. Prevalence of rheumatic diseases in Greece: a cross-sectional population based epidemiological study. The ESORDIG Study. J Rheumatol 2003;30:1589-601). For diseases such as RA, PsA and AS, onset is most frequent between the ages of 30 and 50 years. The impact of inflammatory rheumatic diseases on physical functioning can be significant. Patients can suffer from swollen joints that cause pain and disability. This can reduce sufferers' ability to lead fully productive lives. This has major financial consequences for sufferers and their families and there is an economic impact on society. The National Institute for Health and Clinical Excellence (NICE) technology appraisal process has typically ignored any improvements in productivity that may result from treatment. There have been calls to extend the perspective of economic evaluations to include productivity costs as one aspect of wider social effects. However, there are a number of issues that must be resolved before productivity costs can become a routine input into the calculation of cost-effectiveness of treatments. First, there is limited agreement regarding the practical details and appropriate methods for their inclusion in economic evaluation. Second, there are issues that must be addressed regarding society's preference for equity. This issue arises when considering individual's economic productivity, that is to say, how we weigh individuals who are more productive (e.g. those in employment) against those who are less so (e.g. the unemployed). Finally, it is important to consider cross-budgetary effects, since productivity has cost and benefit implications outside of health.
炎症性风湿病较为常见。据估计，∼2.1%的人口患有炎症性风湿病（Andrianakos A、Trontzas P、Christoyannis F 等。希腊风湿性疾病的患病率：横断面人群流行病学研究。ESORDIG 研究。J Rheumatol 2003；30：1589-601）。对于类风湿关节炎、银屑病关节炎和强直性脊柱炎等疾病，发病最常见于 30 至 50 岁之间。炎症性风湿病对身体功能的影响可能很大。患者可能会出现关节肿胀，导致疼痛和残疾。这会降低患者的生活能力。这对患者及其家庭造成了重大的经济后果，对社会也造成了经济影响。英国国家卫生与临床优化研究所（NICE）的技术评估过程通常忽略了治疗可能带来的生产力提高。有人呼吁将经济评估的视角扩展到包括生产力成本，作为更广泛的社会影响的一个方面。然而，在生产力成本能够成为治疗成本效益计算的常规投入之前，必须解决一些问题。首先，对于纳入经济评估的实际细节和适当方法，尚未达成一致意见。其次，必须解决社会对公平的偏好问题。在考虑个人的经济生产力时，即我们如何权衡生产力更高的个人（例如就业人员）与生产力较低的个人（例如失业人员），就会出现这个问题。最后，必须考虑跨预算的影响，因为生产力在卫生之外具有成本和效益影响。
