Phelps Charles E, Lakdawalla Darius N, Basu Anirban, Drummond Michael F, Towse Adrian, Danzon Patricia M
Economics, Public Health Sciences, Political Science, University of Rochester, Gualala, CA, USA.
Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
Value Health. 2018 Feb;21(2):146-154. doi: 10.1016/j.jval.2017.12.010.
The fifth section of our Special Task Force report identifies and discusses two aggregation issues: 1) aggregation of cost and benefit information across individuals to a population level for benefit plan decision making and 2) combining multiple elements of value into a single value metric for individuals. First, we argue that additional elements could be included in measures of value, but such elements have not generally been included in measures of quality-adjusted life-years. For example, we describe a recently developed extended cost-effectiveness analysis (ECEA) that provides a good example of how to use a broader concept of utility. ECEA adds two features-measures of financial risk protection and income distributional consequences. We then discuss a further option for expanding this approach-augmented CEA, which can introduce many value measures. Neither of these approaches, however, provide a comprehensive measure of value. To resolve this issue, we review a technique called multicriteria decision analysis that can provide a comprehensive measure of value. We then discuss budget-setting and prioritization using multicriteria decision analysis, issues not yet fully resolved. Next, we discuss deliberative processes, which represent another important approach for population- or plan-level decisions used by many health technology assessment bodies. These use quantitative information on CEA and other elements, but the group decisions are reached by a deliberative voting process. Finally, we briefly discuss the use of stated preference methods for developing "hedonic" value frameworks, and conclude with some recommendations in this area.
1）为福利计划决策将个体层面的成本和效益信息汇总到人群层面；2）将多个价值要素整合为个体的单一价值指标。首先，我们认为价值衡量标准中可以纳入更多要素，但这些要素通常未被纳入质量调整生命年的衡量标准中。例如，我们描述了一种最近开发的扩展成本效益分析（ECEA），它很好地展示了如何运用更宽泛的效用概念。ECEA增加了两个特征——金融风险保护措施和收入分配后果。然后，我们讨论了扩展这种方法的另一种选择——增强型成本效益分析（augmented CEA），它可以引入多种价值衡量标准。然而，这两种方法都没有提供全面的价值衡量标准。为解决这个问题，我们回顾了一种称为多标准决策分析的技术，它可以提供全面的价值衡量标准。然后，我们讨论使用多标准决策分析进行预算设定和优先级排序，这些问题尚未得到充分解决。接下来，我们讨论审议过程，这是许多卫生技术评估机构在人群或计划层面决策时采用的另一种重要方法。这些方法使用成本效益分析和其他要素的定量信息，但群体决策是通过审议投票过程达成的。最后，我们简要讨论使用陈述偏好方法来制定“享乐主义”价值框架，并在该领域提出一些建议作为结论。
