Guyatt G, Drummond M, Feeny D, Tugwell P, Stoddart G, Haynes R B, Bennett K, Labelle R
Soc Sci Med. 1986;22(4):393-408. doi: 10.1016/0277-9536(86)90046-8.
The health care system is routinely confronted with promising new technologies. In the past, most new technologies have been integrated into clinical practice without a rigorous demonstration of their effectiveness or efficiency. In order to provide a more rational approach to the adoption and utilization of health technology a comprehensive set of guidelines for both clinical and economic evaluation is proposed. While conceived of as an ideal that is unlikely to be universally met in practice, it is argued that decision making can be improved by striving towards this goal. The clinical guidelines stress the advantages of subjecting major new technologies to randomized controlled trials and insisting upon a demonstration of patient benefit in the application of diagnostic technologies. The economic guidelines stress comparisons with relevant alternative uses of the resources and the assessment of the impact on the quality of life. While application of the guidelines will produce rigorous and useful evidence, the final decisions concerning the allocation of health care resources must rest fundamentally on social value judgements and not solely, or even primarily, on informed expert opinion.
医疗保健系统经常面临有前景的新技术。过去，大多数新技术在未经过严格的有效性或效率论证的情况下就被整合到临床实践中。为了为卫生技术的采用和利用提供更合理的方法，提出了一套全面的临床和经济评估指南。虽然这被视为一个在实践中不太可能普遍实现的理想目标，但有人认为，朝着这个目标努力可以改善决策。临床指南强调对重大新技术进行随机对照试验的优势，并坚持在应用诊断技术时证明对患者有益。经济指南强调与资源的相关替代用途进行比较，并评估对生活质量的影响。虽然指南的应用将产生严谨且有用的证据，但关于医疗保健资源分配的最终决策必须从根本上基于社会价值判断，而不仅仅或甚至主要基于有见识的专家意见。
