Krol Marieke, Brouwer Werner
Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Soc Sci Med. 2015 Nov;144:127-37. doi: 10.1016/j.socscimed.2015.09.008. Epub 2015 Sep 9.
Given its societal importance, unpaid work should be included in economic evaluations of health care technology aiming to take a societal perspective. However, in practice this does not often appear to be the case. This paper provides an overview of the current place of unpaid work in economic evaluations in theory and in practice. It does so first by summarizing recommendations regarding the inclusion of unpaid labor reported in health economic textbooks and national guidelines for economic evaluations. In total, three prominent health economic text-books were studied and 28 national health economic guidelines. The paper, moreover, provides an overview of the instruments available to measure lost unpaid labor and reports on a review of the place of unpaid labor in applied economic evaluations in the area of rheumatoid arthritis. The review was conducted by examining methodology of evaluations published between 1 March 2008 and 1 March 2013. The results of this study show that little guidance is offered regarding the inclusion of unpaid labor in economic evaluations in textbooks and guidelines. The review identified five productivity costs instruments including questions about unpaid work and 33 economic evaluations of treatments for rheumatoid arthritis of which only one included unpaid work. The results indicate that unpaid work is rarely included in applied economic evaluations of treatments for rheumatoid arthritis, despite this disease expecting to be associated with lost unpaid work. Given the strong effects of certain diseases and treatments on the ability to perform unpaid work, unpaid work currently receives less attention in economic evaluations than it deserves.
鉴于无偿工作的社会重要性，在旨在从社会角度进行的医疗技术经济评估中应纳入无偿工作。然而，在实践中情况往往并非如此。本文概述了无偿工作在理论和实践的经济评估中的当前地位。首先，通过总结卫生经济教科书和国家经济评估指南中关于纳入无偿劳动的建议来进行概述。总共研究了三本著名的卫生经济教科书和28份国家卫生经济指南。此外，本文还概述了可用于衡量无偿劳动损失的工具，并报告了对类风湿关节炎领域应用经济评估中无偿劳动地位的综述。该综述通过审查2008年3月1日至2013年3月1日期间发表的评估方法进行。这项研究的结果表明，教科书和指南中关于在经济评估中纳入无偿劳动的指导很少。该综述确定了五种生产力成本工具，包括关于无偿工作的问题，以及33项类风湿关节炎治疗的经济评估，其中只有一项纳入了无偿工作。结果表明，尽管类风湿关节炎预计会导致无偿工作的损失，但在类风湿关节炎治疗的应用经济评估中很少纳入无偿工作。鉴于某些疾病和治疗对从事无偿工作能力的强烈影响，无偿工作目前在经济评估中受到的关注低于其应得的程度。
