Claxton Karl, Sculpher Mark, Palmer Stephen, Culyer Anthony J
Department of Economics and Related Studies, University of York; Centre for Health Economics, University of York.
Health Econ. 2015 Jan;24(1):1-7. doi: 10.1002/hec.3130.
Organisations across diverse health care systems making decisions about the funding of new medical technologies face extensive stakeholder and political pressures. As a consequence, there is quite understandable pressure to take account of other attributes of benefit and to fund technologies, even when the opportunity costs are likely exceed the benefits they offer. Recent evidence suggests that NICE technology appraisal is already approving drugs where more health is likely to be lost than gained. Also, NICE recently proposed increasing the upper bound of the cost-effectiveness threshold to reflect other attributes of benefit but without a proper assessment of the type of benefits that are expected to be displaced. It appears that NICE has taken a direction of travel, which means that more harm than good is being, and will continue to be, done, but it is unidentified NHS patients who bear the real opportunity costs.
不同医疗保健系统中负责决定新医疗技术资金投入的组织面临着来自利益相关者和政治方面的巨大压力。因此，即使机会成本可能超过所提供的益处，考虑效益的其他属性并为技术提供资金的压力也是完全可以理解的。最近的证据表明，英国国家卫生与临床优化研究所（NICE）的技术评估已经批准了一些药物，在这些药物上可能失去的健康比获得的更多。此外，NICE最近提议提高成本效益阈值的上限，以反映效益的其他属性，但却没有对预期被取代的效益类型进行适当评估。似乎NICE已经走上了一条道路，这意味着正在并将继续造成弊大于利的结果，但承担实际机会成本的却是身份不明的国民保健服务（NHS）患者。
