Vermeulen Karin M, Krabbe Paul F M
Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Cost Eff Resour Alloc. 2018 Apr 17;16:16. doi: 10.1186/s12962-018-0099-6. eCollection 2018.
The healthcare sector is evolving while life expectancy is increasing. These trends put greater pressure on healthcare resources, prompt healthcare reforms, and demand transparent arguments and criteria to assess the overall value of health interventions. There is no consensus on the core criteria by which to value and prioritize interventions, and individual stakeholders might value specific elements differently. The present study is based on a literature review that retrieved the most widely recognized arguments and criteria used in decision-making. The aim was to compile a smaller set of arguments and criteria that would seem most relevant to different stakeholders.
A literature review was performed in Medline and EMBASE. The initial search retrieved over 2000 articles and documents of relevant committees. A selection was made based on their reference to healthcare, policy issues, or social justice. Finally, 84 papers were included. Data extraction took place after appraisal of the articles. A full table was made, including all arguments and criteria found; next, identical or largely overlapping arguments were excluded. The remaining arguments and criteria were assessed for relevance and a reduced set was compiled.
The final set included 25 arguments and criteria, categorized by type (clinical, social justice, ethical, and policy). For each argument and criterion, relevance to stakeholders was scored on three levels (not, partly, and completely relevant).
Many arguments and criteria play a role in making value judgments on health interventions, but not all are relevant to all interventions. Moreover, they may interact with each other. A viable way to deal with interacting and possibly conflicting arguments and criteria might be to arrange public discussions that would evoke different stakeholders' perspectives.
随着预期寿命的增加，医疗保健行业也在不断发展。这些趋势给医疗资源带来了更大压力，促使医疗改革，同时也需要透明的论据和标准来评估健康干预措施的整体价值。对于评估干预措施的价值和优先级的核心标准，目前尚无共识，而且不同的利益相关者对具体要素的重视程度可能不同。本研究基于一项文献综述，该综述检索了决策过程中最广泛认可的论据和标准。目的是汇编一组对不同利益相关者似乎最相关的较小的论据和标准。
在Medline和EMBASE数据库中进行了文献综述。初步检索获得了2000多篇相关委员会的文章和文件。根据它们对医疗保健、政策问题或社会正义的提及进行筛选。最后，纳入了84篇论文。在对文章进行评估后进行数据提取。制作了一个完整的表格，包括所有找到的论据和标准；接下来，排除相同或基本重叠的论据。对其余的论据和标准进行相关性评估，并汇编出一个精简的集合。
最终集合包括25个论据和标准，按类型（临床、社会正义、伦理和政策）进行分类。对于每个论据和标准，与利益相关者的相关性在三个级别上进行评分（不相关、部分相关和完全相关）。
许多论据和标准在对健康干预措施进行价值判断时发挥作用，但并非所有论据和标准都与所有干预措施相关。此外，它们可能相互影响。处理相互作用且可能相互冲突的论据和标准的一个可行方法可能是安排公众讨论，以唤起不同利益相关者的观点。
