Institute of Leadership and Management in Health, Kingston University, London, United Kingdom.
Clin Ther. 2013 Jul;35(7):904-14. doi: 10.1016/j.clinthera.2013.05.003. Epub 2013 Jun 24.
A large number of economic evaluations have already confirmed the cost-effectiveness of different human papillomavirus (HPV) vaccination strategies. Standard analyses might not capture the full economic value of novel vaccination programs because the cost-effectiveness paradigm fails to take into account the value of active management. Management decisions can be seen as real options, a term used to refer to the application of option pricing theory to the valuation of investments in nonfinancial assets in which much of the value is attributable to flexibility and learning over time.
The aim of this article was to discuss the potential advantages shown by using the payoff method in the valuation of the cost-effectiveness of competing HPV immunization programs.
This was the first study, to the best of our knowledge, to use the payoff method to determine the real option values of 4 different HPV vaccination strategies targeting female subjects aged 12, 15, 18, and 25 years. The payoff method derives the real option value from the triangular payoff distribution of the project's net present value, which is treated as a triangular fuzzy number. To inform the real option model, cost-effectiveness data were derived from an empirically calibrated Bayesian model designed to assess the cost-effectiveness of a multicohort HPV vaccination strategy in the context of the current cervical cancer screening program in Italy. A net health benefit approach was used to calculate the expected fuzzy net present value for each of the 4 vaccination strategies evaluated.
Costs per quality-adjusted life-year gained seemed to be related to the number of cohorts targeted: a single cohort of girls aged 12 years (€10,955 [95% CI, -1,021 to 28,212]) revealed the lowest cost among the 4 alternative strategies evaluated. The real option valuation challenged the cost-effectiveness dominance of a single cohort of 12-year-old girls. The simultaneous vaccination of 2 cohorts of girls aged 12 and 15 years yielded a real option value (€17,723) equivalent to that attributed to a single cohort of 12-year-old girls (€17,460).
The payoff method showed distinctive advantages in the valuation of the cost-effectiveness of competing health care interventions, essentially determined by the replacement of the nonfuzzy numbers that are commonly used in cost-effectiveness analysis models, with fuzzy numbers as an input to inform the real option pricing method. The real option approach to value uncertainty makes policy making in health care an evolutionary process and creates a new "space" for decision-making choices.
大量经济评估已经证实了不同人乳头瘤病毒（HPV）疫苗接种策略的成本效益。标准分析可能无法捕捉到新型疫苗接种计划的全部经济价值，因为成本效益范式未能考虑到主动管理的价值。管理决策可以被视为实物期权，这一术语用于将期权定价理论应用于金融资产以外的投资价值评估，其中大部分价值归因于灵活性和随时间推移的学习。
本文旨在讨论使用收益法评估竞争 HPV 免疫接种计划的成本效益时显示出的潜在优势。
据我们所知，这是首次使用收益法来确定针对 12 岁、15 岁、18 岁和 25 岁女性目标的 4 种不同 HPV 疫苗接种策略的实物期权价值。收益法从项目净现值的三角收益分布中得出实物期权价值，该分布被视为三角模糊数。为了为实物期权模型提供信息，成本效益数据源自经验校准的贝叶斯模型，旨在评估意大利当前宫颈癌筛查计划背景下多队列 HPV 疫苗接种策略的成本效益。使用净健康收益方法计算了所评估的 4 种疫苗接种策略中的每一种的预期模糊净现值。
每获得一个质量调整生命年的成本似乎与目标人群的数量有关：针对 12 岁女孩的单一队列（€10,955 [95% CI，-1,021 至 28,212]）显示出 4 种备选策略中最低的成本。实物期权估值对单一 12 岁女孩队列的成本效益优势提出了挑战。同时接种 12 岁和 15 岁的 2 个女孩队列产生的实物期权价值（€17,723）与针对 12 岁女孩的单一队列的实物期权价值（€17,460）相当。
收益法在评估竞争医疗保健干预措施的成本效益方面显示出明显的优势，这主要是通过用模糊数作为输入来通知实物期权定价方法，从而用模糊数替代成本效益分析模型中常用的非模糊数。实物期权方法对价值不确定性的处理使得医疗保健政策制定成为一个进化过程，并为决策选择创造了一个新的“空间”。
