April Michael D, Murray Brian P
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.
Acad Emerg Med. 2017 Jun;24(6):754-768. doi: 10.1111/acem.13186. Epub 2017 May 11.
Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation studies.
成本效益是急诊医疗服务的一个重要目标。急诊科做出的众多诊断、治疗和处置决策对医疗资源的利用有着重大影响。成本效益分析（CEA）是一种分析工具，通过系统比较替代医疗决策的成本和效果来优化这些资源分配决策。然而，很少有急诊医学领域的领导者和政策制定者接受过CEA方法的正规培训。本文介绍了CEA的解读和应用，重点是其在急诊医学问题和场景中的应用。它将先前发表的CEA应用于一名因胸痛就诊于急诊科且需要进行风险分层的患者的假设案例。本文使用了一份被广泛引用的清单来评估该CEA。这份清单作为呈现基本CEA术语和概念的工具。重点关注的一般主题包括成本和结果的测量、增量分析和敏感性分析。贯穿全文的是关于良好CEA实践的建议，重点是美国卫生与医学成本效益小组发布的指南。讨论的急诊医学CEA面临的独特挑战包括从紧急干预预测长期结果、急诊科服务成本核算以及将研究结果应用于不同急诊科环境中的不同患者群体。讨论还包括对将CEA结果应用于临床实践所固有的局限性的概述，包括CEA中未纳入非成本考虑因素（如伦理）。阅读本文后，急诊医学领域的领导者和研究人员将对CEA关键评估和应用的基础知识有更深入的理解。本文最后为有兴趣开展基于急诊科的经济评估研究的读者概述了经济评估资源。
