Paulden Mike, O'Mahony James, McCabe Christopher
Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada (MP, CM).
Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland (JOM).
Med Decis Making. 2017 Feb;37(2):264-276. doi: 10.1177/0272989X16662242. Epub 2016 Sep 27.
The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants. Where the health care system is technically efficient, an increase in the health care budget unambiguously raises the threshold, whereas an increase in the demand for existing, non-marginal health interventions unambiguously lowers the threshold. Improvements in the technical efficiency of existing interventions may raise or lower the threshold, depending on the cause of the improvement in efficiency, whether the intervention is already funded, and, if so, whether it is marginal. New technologies may also raise or lower the threshold, depending on whether the new technology is a substitute for an existing technology and, again, whether the existing technology is marginal. Our analysis permits health economists and decision makers to assess if and in what direction the threshold may change over time. This matters, as threshold changes impact the cost-effectiveness of interventions that require decisions now but have costs and effects that fall in future periods.
在预算有限的医疗保健系统中，成本效益阈值应由将医疗保健服务挪用以资助新干预措施的成本效益来确定。运用比较静态分析方法，我们审视了该阈值的一些潜在决定因素，包括医疗保健预算、对现有医疗保健干预措施的需求、现有干预措施的技术效率以及新医疗技术的发展情况。我们考虑了这些决定因素中每一个发生变化后，预期会对阈值产生影响的方向。在医疗保健系统技术效率较高的情况下，医疗保健预算的增加会明确提高阈值，而对现有非边际医疗干预措施需求的增加则会明确降低阈值。现有干预措施技术效率的提高可能会提高或降低阈值，这取决于效率提高的原因、该干预措施是否已获资助，以及如果已获资助，它是否处于边际状态。新技术也可能提高或降低阈值，这取决于新技术是否是现有技术的替代品，以及同样地，现有技术是否处于边际状态。我们的分析使卫生经济学家和决策者能够评估阈值是否以及可能会朝什么方向随时间变化。这很重要，因为阈值变化会影响那些现在需要做出决策，但成本和效果却在未来时期才显现的干预措施的成本效益。
