Weinstein M C
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
J Gen Intern Med. 1990 Sep-Oct;5(5 Suppl):S89-92. doi: 10.1007/BF02600850.
A prevention program is cost-effective if it yields more health benefits than do alternative uses of health care resources. Some prevention programs meet this standard: either they actually save more health care resources than they utilize, or their net costs per healthy year of life gained are lower than those of alternatives such as curative or palliative medicine. Other prevention programs, however, are less cost-effective than are medical treatments for the same disease. One lesson for public policy is that generalizations about the cost-effectiveness of "prevention" are unwise. Another lesson is that prevention programs should not be subjected to a higher standard than other health programs: they should not be expected to save money, but they should be expected to yield improved health at a reasonable price.
如果一个预防项目产生的健康效益超过医疗保健资源的其他用途，那么它就是具有成本效益的。一些预防项目符合这一标准：要么它们实际节省的医疗保健资源多于其使用的资源，要么其每获得一个健康生命年的净成本低于诸如治疗或姑息治疗等替代方案。然而，其他预防项目的成本效益低于针对同一种疾病的医疗治疗。公共政策可以吸取的一个教训是，对“预防”的成本效益进行一概而论是不明智的。另一个教训是，预防项目不应受到比其他健康项目更高的标准要求：不应期望它们省钱，但应期望它们以合理的价格带来健康改善。
