Ward Derek, Martino Orsolina, Packer Claire, Simpson Sue, Stevens Andrew
Clinical Senior Lecturer, NIHR Horizon Scanning Centre, University of Birmingham, UK.
Research Fellow, NIHR Horizon Scanning Centre, University of Birmingham, UK
J Health Serv Res Policy. 2013 Apr;18(1 Suppl):7-13. doi: 10.1177/1355819613476015.
New and emerging health technologies (innovation outputs) do not always reflect conditions representing the greatest disease burden. We examine the role of research and development (R&D) funding in this relationship, considering whether areas with fewer innovative outputs receive an appropriate share of funding relative to their disease burden.
We report a retrospective observational study, comparing burden of disease with R&D funding and innovation output. UK disability-adjusted life years (DALYs) and deaths came from the World Health Organization (WHO) 2004 Global Burden of Disease estimates; funding estimates from the UK Clinical Research Collaboration's 2006 Health Research Analysis; and innovation output was estimated by the number of new and emerging technologies reported by the National Institute for Health Research (NIHR) Horizon Scanning Centre between 2000 and 2009.
Disease areas representing the biggest burden were generally associated with the most funding and innovation output; cancer, neuropsychiatric conditions and cardiovascular disease together comprised approximately two-thirds of DALYs, funding and reported technologies. Compared with DALYs, funding and technologies were disproportionately high for cancer, and technologies alone were disproportionately high for musculoskeletal conditions and endocrine/metabolic diseases. Neuropsychiatric conditions had comparatively few technologies compared to both DALYs and funding. The relationship between DALYs and innovation output appeared to be mediated by R&D funding.
The relationship between burden of disease and new and emerging health technologies for different disease areas is partly dependent on the associated level of R&D funding (input). Discrepancies among key groups may reflect differential focus of research funding across disease areas.
新出现的卫生技术(创新成果)并不总是反映代表最大疾病负担的状况。我们研究了研发资金在这种关系中的作用,考虑创新成果较少的领域相对于其疾病负担是否获得了适当份额的资金。
我们报告了一项回顾性观察性研究,比较疾病负担与研发资金及创新成果。英国的伤残调整生命年(DALYs)和死亡数据来自世界卫生组织(WHO)2004年全球疾病负担估计;资金估计来自英国临床研究协作组织2006年的卫生研究分析;创新成果通过国家卫生研究院(NIHR)地平线扫描中心在2000年至2009年期间报告的新兴技术数量来估计。
代表最大负担的疾病领域通常与最多的资金和创新成果相关;癌症、神经精神疾病和心血管疾病合计约占伤残调整生命年、资金和报告技术的三分之二。与伤残调整生命年相比,癌症的资金和技术占比过高,仅技术方面,肌肉骨骼疾病和内分泌/代谢疾病的占比过高。与伤残调整生命年和资金相比,神经精神疾病的技术相对较少。伤残调整生命年与创新成果之间的关系似乎由研发资金介导。
不同疾病领域的疾病负担与新兴卫生技术之间的关系部分取决于相关的研发资金水平(投入)。关键群体之间的差异可能反映了不同疾病领域研究资金的不同重点。