Altarum Institute, Ann Arbor, MI 48105, USA.
Health Care Manag Sci. 2013 Jun;16(2):87-100. doi: 10.1007/s10729-012-9215-x. Epub 2012 Oct 23.
It is widely believed that the US health care system needs to transition from a culture of reactive treatment of disease to one of proactive prevention. As a tool for understanding the appropriate allocation of spending to prevention versus treatment (including research into improved prevention and treatment), a simple Markov model is used to represent the flow of individuals among states of health, where the transition rates are governed by the magnitude of appropriately-lagged expenditures in each of these categories. The model estimates the discounted cost and discounted effectiveness (measured in quality adjusted life years or QALYs) associated with a given spending mix, and it allows computing the marginal cost-effectiveness associated with additional spending in a category. We apply the model to explore interactions of alternative investments in cardiovascular disease (CVD) and to identify an optimal spending mix. Under the assumptions of our model structure, we find that the marginal cost-effectiveness of prevention of CVD varies with changes in spending on treatment (and vice versa), and that the optimal mix of CVD spending (i.e., the spending mix that maximizes the overall QALYs achieved) would, indeed, shift spending from treatment to prevention.
人们普遍认为，美国的医疗保健系统需要从疾病的被动治疗文化转变为主动预防文化。作为理解将支出用于预防与治疗（包括研究改进的预防和治疗）的适当分配的工具，使用简单的马尔可夫模型来表示健康状态个体之间的流动，其中转移率由这些类别中适当滞后的支出的大小决定。该模型估计了与给定支出组合相关的贴现成本和贴现效果（以质量调整生命年或 QALYs 衡量），并允许计算与该类别中额外支出相关的边际成本效益。我们应用该模型来探索心血管疾病（CVD）替代投资的相互作用，并确定最佳支出组合。在我们的模型结构的假设下，我们发现 CVD 预防的边际成本效益随治疗支出的变化而变化（反之亦然），并且 CVD 支出的最佳组合（即，使实现的总体 QALYs 最大化的支出组合）确实会将支出从治疗转移到预防。
