Departement of Health Administration, University of Montreal, Montreal, Canada.
Int J Technol Assess Health Care. 2012 Apr;28(2):125-32. doi: 10.1017/S0266462312000050. Epub 2012 Apr 12.
The aim of this study was to promote approaches to health technology assessment (HTA) that are both evidence-based and values-based. We conducted a systematic review of published studies describing formal methods to consider equity in the context of cost-effectiveness analysis (CEA).
Candidate studies were identified through an unrestricted search of the Pub Med and EMBASE databases. The search closed on January 20, 2011. We identified additional studies by consulting experts and checking article bibliographies. Two authors independently reviewed each candidate study to determine inclusion and extracted data from studies retained for review. In addition to documenting methods, data extraction identified implicit and explicit notions of fairness. Data were synthesized in narrative form. Study quality was not assessed.
Of the 695 candidate articles, 51 were retained for review. We identified three broad methods to facilitate quantitative consideration of equity concerns in economic evaluation: integration of distributional concerns through equity weights and social welfare functions, exploration of the opportunity costs of alternative policy options through mathematical programming, and multi-criteria decision analysis.
Several viable techniques to integrate equity concerns within CEA now exist, ranging from descriptive approaches to the quantitative methods studied in this review. Two obstacles at the normative level have impeded their use in decision making to date: the multiplicity of concepts and values discussed under the rubric of equity, and the lack of a widely accepted normative source on which to ground controversial value choices. Clarification of equity concepts and attention to procedural fairness may strengthen use of these techniques in HTA decision making.
本研究旨在促进基于证据和价值的卫生技术评估（HTA）方法。我们对描述在成本效益分析（CEA）背景下考虑公平性的正式方法的已发表研究进行了系统回顾。
通过对 Pub Med 和 EMBASE 数据库的无限制搜索来确定候选研究。搜索于 2011 年 1 月 20 日关闭。我们通过咨询专家和检查文章参考文献来确定其他研究。两位作者独立审查了每个候选研究，以确定是否纳入，并从保留进行审查的研究中提取数据。除了记录方法外，数据提取还确定了公平的隐含和显式概念。数据以叙述形式综合。未评估研究质量。
在 695 篇候选文章中，有 51 篇被保留进行综述。我们确定了三种广泛的方法，以促进在经济评估中定量考虑公平问题：通过公平权重和社会福利函数整合分配问题，通过数学规划探索替代政策选择的机会成本，以及多标准决策分析。
目前存在几种将公平问题纳入 CEA 的可行技术，从描述性方法到本综述中研究的定量方法不等。在规范层面上存在两个障碍，阻碍了它们在决策中的应用：公平概念下讨论的概念和价值观的多样性，以及缺乏一个广泛接受的规范来源来为有争议的价值选择提供依据。澄清公平概念并关注程序公平性可能会加强这些技术在 HTA 决策中的应用。
