Lakdawalla Darius, Shafrin Jason, Lucarelli Claudio, Nicholson Sean, Khan Zeba M, Philipson Tomas J
Darius Lakdawalla (
Jason Shafrin is a senior research economist at Precision Health Economics, in Los Angeles.
Health Aff (Millwood). 2015 Apr;34(4):555-61. doi: 10.1377/hlthaff.2014.0639.
Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for.
技术推动了医疗保健支出和健康改善。然而，政策制定者很少看到能兼顾这两种影响的成本增长衡量指标。为了填补这一空白，我们提出了质量调整后的护理成本，它说明了扣除健康改善价值增长后的成本增长情况，健康改善价值增长以生存收益乘以生存价值来衡量。我们将质量调整后的护理成本应用于两个案例。对于结直肠癌，由于新药上市，1998年至2005年间每位患者的药物成本增加了34,493美元，但抵消健康改善带来的价值后，质量调整后的护理成本仅适度增加了1,377美元。对于多发性骨髓瘤，2004年至2009年间新疗法使治疗成本增加了72,937美元，但抵消健康益处后，总体质量调整后的护理成本降低了67,863美元。然而，接受既定一线疗法的多发性骨髓瘤患者的成本上升了，却没有相应的益处。所有这三个例子都表明成本增长迅速，但对于社会是否物有所值这个问题，它们给出了截然不同的答案。
