Richardson Jeff, Iezzi Angelo, Chen Gang, Maxwell Aimee
Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia.
Pharmacoecon Open. 2017 Mar;1(1):13-23. doi: 10.1007/s41669-016-0002-3.
This paper suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective, i.e. when more health could be produced by allocating funds to other services. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost.
Survey respondents were asked to allocate a budget between cost-effective services that had a small effect upon a large number of relatively well patients and SRDs that benefited a small number of severely ill patients but were not cost effective because of their high cost.
Part of the budget was always allocated to the SRDs. The budget share rose with the number sharing the cost.
Sharing per se appears to characterise preferences. This has been obscured in studies that focus upon cost per patient rather than cost per person sharing the cost.
本文提出并验证了一个问题，即当针对罕见病的服务有效但不具有成本效益时（也就是说，将资金分配给其他服务可产生更多健康效益时），公众为何仍可能支持为这些服务提供资金。据推测，为一项服务提供资金的公平性受平均患者受益与分担成本者的平均成本之比的影响。
调查对象被要求在两类服务之间分配预算，一类是对大量病情相对较轻的患者有较小影响的具有成本效益的服务，另一类是使少数重症患者受益但因成本高昂而不具有成本效益的罕见病服务。
总有一部分预算被分配给罕见病服务。预算份额随分担成本的人数增加而上升。
分担本身似乎体现了偏好。这一点在那些关注每位患者成本而非分担成本的人均成本的研究中被掩盖了。
