Incerti Devin, Browne John, Huber Caroline, Baker Christine L, Makinson Geoff, Goren Amir, Willke Richard, Stevens Warren
Precision Health Economics, 11100 Santa Monica Blvd #500, Los Angeles, CA, 90025, USA.
University College Cork, College Rd, University College, Cork, Ireland.
BMC Health Serv Res. 2019 Feb 11;19(1):113. doi: 10.1186/s12913-019-3914-7.
Although there has been growing attention to the measurement of unmet need, which is the overall epidemiological burden of disease, current measures ignore the burden that could be eliminated from technological advances or more effective use of current technologies.
We developed a conceptual framework and empirical tool that separates unmet need from met need and subcategorizes the causes of unmet need into suboptimal access to and ineffective use of current technologies and lack of current technologies. Statistical models were used to model the relationship between health-related quality of life (HR-QOL) and treatment utilization using data from the National Health and Wellness Survey (NHWS). Predicted HR-QOL was combined with prevalence data from the Global Burden of Disease Study (GBD) to estimate met need and the causes of unmet need due to morbidity in the US and EU5 for five diseases: rheumatoid arthritis, breast cancer, Parkinson's disease, hepatitis C, and chronic obstructive pulmonary disease (COPD).
HR-QOL was positively correlated with adherence to medication and patient-perceived quality and negatively correlated with financial barriers. Met need was substantial across all disease and regions, although significant unmet need remains. While the majority of unmet need was driven by lack of technologies rather than ineffective use of current technologies, there was considerable variation across diseases and regions. Overall unmet need was largest for COPD, which had the highest prevalence of all diseases in this study.
We developed a methodology that can inform decisions about which diseases to invest in and whether those investments should focus on improving access to currently available technologies or inventing new technologies.
尽管对未满足需求的衡量（即疾病的总体流行病学负担）的关注日益增加，但当前的衡量方法忽略了可通过技术进步或更有效地利用现有技术消除的负担。
我们开发了一个概念框架和实证工具，将未满足需求与已满足需求区分开来，并将未满足需求的原因细分为获得现有技术的机会不足和使用效率低下以及缺乏现有技术。使用来自国民健康与幸福调查（NHWS）的数据，通过统计模型对健康相关生活质量（HR-QOL）与治疗利用之间的关系进行建模。将预测的HR-QOL与全球疾病负担研究（GBD）的患病率数据相结合，以估计美国和欧盟五国（EU5）五种疾病（类风湿性关节炎、乳腺癌、帕金森病、丙型肝炎和慢性阻塞性肺疾病（COPD））的已满足需求以及因发病导致的未满足需求的原因。
HR-QOL与药物依从性和患者感知质量呈正相关，与经济障碍呈负相关。尽管仍存在显著的未满足需求，但在所有疾病和地区，已满足需求都相当可观。虽然大多数未满足需求是由缺乏技术而非现有技术使用效率低下导致的，但不同疾病和地区存在相当大的差异。总体而言，COPD的未满足需求最大，在本研究的所有疾病中其患病率最高。
我们开发了一种方法，可为有关投资哪些疾病以及这些投资应侧重于改善获得现有技术的机会还是发明新技术的决策提供信息。
