Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
Eur J Health Econ. 2019 Jul;20(5):751-762. doi: 10.1007/s10198-019-01039-0. Epub 2019 Feb 22.
Although cost-effectiveness analysis has a long tradition of supporting healthcare decision-making in Sweden, there are no clear criteria for when an intervention is considered too expensive. In particular, the opportunity cost of healthcare resource use in terms of health forgone has not been investigated empirically. In this work, we therefore seek to estimate the marginal cost of a life year in Sweden's public healthcare sector using time series and panel data at the national and regional levels, respectively. We find that estimation using time series is unfeasible due to reversed causality. However, through panel instrumental variable estimation we are able to derive a marginal cost per life year of about SEK 370,000 (EUR 39,000). Although this estimate is in line with emerging evidence from other healthcare systems, it is associated with uncertainty, primarily due to the inherent difficulties of causal inference using aggregate observational data. The implications of these difficulties and related methodological issues are discussed.
尽管成本效益分析在瑞典有着悠久的支持医疗保健决策的传统，但对于何时认为干预措施过于昂贵，尚无明确的标准。特别是，尚未从经验上研究过放弃健康所带来的医疗资源使用的机会成本。在这项工作中，我们分别使用时间序列和面板数据来估计瑞典公共医疗保健部门中每增加一年生命的边际成本。我们发现，由于反向因果关系，使用时间序列进行估计是不可行的。但是，通过面板工具变量估计，我们能够得出每增加一年生命的边际成本约为 370,000 瑞典克朗（39,000 欧元）。尽管这一估计与其他医疗保健系统的新出现的证据相符，但它存在不确定性，主要是由于使用汇总观测数据进行因果推断所固有的困难。讨论了这些困难和相关方法问题的影响。
