University of York - Economics & Related
Int J Technol Assess Health Care. 2018 Jan;34(5):434-441. doi: 10.1017/S0266462318000612. Epub 2018 Oct 17.
This study is an attempt to demystify and clarify the idea of cost in health economics and health technology assessment (HTA).
Its method draws on standard concepts in economics. Cost is a more elusive concept than is commonly thought and can be particularly elusive in multidisciplinary territory like HTA.
The article explains that cost is more completely defined as opportunity cost, why cost is necessarily associated with a decision, and that it will always vary according to the context of that decision: whether choice is about inputs or outputs, what the alternatives are, the timing of the consequences of the decision, the nature of the commitment to which a decision maker is committed, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short and long runs and between fixed and variable inputs are matters of choice, not technology, and are similarly context-dependent. Harms or negative consequences are, in general, not costs. Whether so-called "clinically unrelated" future costs and benefits should be counted in current decisions again depends on context.
The costs of entire health programs are context-dependent, relating to planned rates of activity, volumes, and timings. The implications for the methods of HTA are different in the contexts of low- and middle-income countries compared with high-income countries, and further differ contextually according to the budget constraints (fixed or variable) facing decision makers.
本研究试图阐明和澄清卫生经济学和卫生技术评估（HTA）中成本的概念。
其方法借鉴了经济学中的标准概念。与人们普遍认为的相反，成本是一个比想象中更难以捉摸的概念，在 HTA 等多学科领域尤其难以捉摸。
本文解释了成本更完整的定义为机会成本，为什么成本必然与决策相关，并且根据决策的上下文，成本将始终有所不同：无论是关于投入还是产出的选择，替代方案是什么，决策后果的时间，决策者承诺的承诺的性质，决策者是谁以及限制或释放决策者的约束和酌处权。短期和长期之间以及固定投入和可变投入之间的区别是选择的问题，而不是技术，同样取决于上下文。危害或负面后果通常不是成本。在当前决策中是否应考虑所谓的“临床无关”未来成本和收益再次取决于上下文。
整个卫生计划的成本取决于计划的活动、数量和时间的发生频率。这对中低收入国家与高收入国家的 HTA 方法产生了不同的影响，并且根据决策者面临的预算限制（固定或可变）进一步根据上下文而有所不同。
