Gerber-Grote Andreas, Sandmann Frank Gerd, Zhou Min, Ten Thoren Corinna, Schwalm Anja, Weigel Carolin, Balg Christiane, Mensch Alexander, Mostardt Sarah, Seidl Astrid, Lhachimi Stefan K
Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):390-6. doi: 10.1016/j.zefq.2014.06.018. Epub 2014 Aug 7.
For many years, the legal situation within the statutory health insurance (SHI) system in Germany has allowed for health economic evaluations. There are various reasons why health economic evaluations have played virtually no role in decision making until now: to begin with, a method for the evaluation of the relation between benefits and costs which needed to be in accordance with the legal requirements had to be developed, the outcome of which was the efficiency frontier approach. Subsequent health care reforms have led to changing objectives and strategies. Currently, price negotiations of newly launched drugs are based on an early benefit assessment of dossiers submitted by pharmaceutical manufacturers. Other reasons might be the presently very comfortable financial situation of the statutory health insurance system as well as a historically grown societal fear and discomfort towards what is perceived to be a rationing of medicinal products. For the time being, it remains open how long the German health care system can afford to continue neglecting the benefits of health economic evaluations for drug and non-drug interventions, and when it will be time to wake this sleeping beauty.
多年来，德国法定医疗保险（SHI）体系内的法律状况允许进行卫生经济评估。卫生经济评估至今在决策中几乎未发挥作用，原因有多种：首先，必须开发一种符合法律要求的效益与成本关系评估方法，其结果就是效率前沿方法。随后的医疗改革导致目标和策略不断变化。目前，新上市药品的价格谈判基于制药商提交档案的早期效益评估。其他原因可能是法定医疗保险体系目前非常宽松的财务状况，以及历史上形成的社会对药品配给的恐惧和不适。目前尚不清楚德国医疗体系能在多长时间内继续忽视卫生经济评估对药品和非药品干预措施的益处，以及何时该唤醒这位沉睡的美人。
