University of York.
J Health Polit Policy Law. 2013 Dec;38(6):1081-102. doi: 10.1215/03616878-2373148. Epub 2013 Aug 23.
The objective of this article is to examine the impact of economic evaluation on the reimbursement process for pharmaceuticals. The changes in the structure of reimbursement policies necessary to incorporate economic evaluation have been accomplished without major difficulty in most jurisdictions. However, several methodological differences in international guidelines for economic evaluation exist, only some of which can easily be justified. A number of beneficial changes in reimbursement processes have also been observed, such as a trend toward requiring the measurement of more meaningful clinical end points and increased engagement between manufacturers, drug regulators, and payers. A consistent finding in studies of reimbursement decisions is that economic considerations have been influential, second only to the strength of the clinical evidence for the drug of interest. The impact of economic evaluation on the allocation of health care resources is hard to ascertain because little is known about the extent to which reimbursement decisions actually lead to changes in health care practice. However, there is evidence that economic evaluation has assisted price negotiations and enabled reimbursement agencies to target drugs to those patients who will benefit the most.
本文旨在探讨经济评估对药品报销流程的影响。在大多数司法管辖区，已经完成了对纳入经济评估所需的报销政策结构的改变，没有遇到重大困难。然而，国际经济评估指南中存在一些方法学差异，其中只有一些差异可以轻易得到证明。在报销流程中也观察到了一些有益的变化，例如越来越倾向于要求测量更有意义的临床终点，以及制造商、药品监管机构和支付方之间的参与度增加。在报销决策的研究中，一个一致的发现是，经济考虑因素具有影响力，仅次于相关药物的临床证据强度。经济评估对卫生保健资源配置的影响难以确定，因为人们对报销决策实际上在多大程度上导致卫生保健实践的改变知之甚少。然而，有证据表明，经济评估有助于价格谈判，并使报销机构能够将药物针对那些最能受益的患者。
