Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Int J Health Policy Manag. 2014 Oct 27;3(6):323-32. doi: 10.15171/ijhpm.2014.105. eCollection 2014 Nov.
The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases.
A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions.
This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies.
Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.
将成本效益数据纳入优先级设置排名，是制定瑞典国家指南的一个显著特征。这些指南的制定旨在直接影响卫生政策，并支持有关稀缺医疗资源有效分配的决策。某些医疗条件可能会获得更高的优先级排名，即获得比其他条件更多的资源，这取决于医疗条件的严重程度。本研究调查了决策小组——优先级设置小组（PSG）如何在心脏病国家指南中使用成本效益数据对优先级设置决策进行排名。
采用定性案例研究方法，探讨了在对医疗保健决策进行优先级排序时使用此类数据的情况。本研究涉及成本效益数据的可用性、证据理解、解释困难以及对证据的依赖。我们还对数据在排名决策中的明确使用，特别是在经济论点影响决策背后推理的情况下感兴趣。
本研究表明，成本效益数据是决策过程中的一个重要且不可或缺的部分。健康经济学家的参与和对数据的依赖促进了成本效益数据的使用。经济论点既被用作微调工具，也被用作二分法的制衡手段。当总体证据基础薄弱且决策者由于缺乏临床证据和不确定性而难以做出决策时，会使用成本效益数据。成本效益数据也用于决定引入新的昂贵医疗技术。
成本效益数据在决策过程中很重要，本研究的结果可能适用于其他实施卫生经济学的司法管辖区。本研究有助于了解成本效益数据在实际决策中的使用情况，以确保决策是在平等的基础上提出的，并且患者根据其需求获得医疗护理，以实现最大效益。
