Centre for Health Economics, Alcuin a Block, University of York, York, YO10 5DD, UK.
LSE Health, London School of Economics, London, UK.
Appl Health Econ Health Policy. 2019 Oct;17(5):577-590. doi: 10.1007/s40258-019-00481-8.
In most societies, resources are distributed by individuals acting in markets and by governments through some form of collective decision-making process. Economic evaluation offers a set of tools to inform collective decisions by examining the resource requirements and outcomes of alternative policies. The 'societal perspective' has been advocated, but less consideration has been given to what this should include and its practical implementation. This paper presents a framework for economic evaluation of policies with costs and outcomes falling on different sectors (e.g. health, criminal justice, education) and involving different decision makers. It extends the 'impact inventory' developed by the Second Panel on Cost-Effectiveness in Health and Medicine by considering all affected individuals and reflecting how outcomes attributed to an intervention can be compared with outcomes forgone as a result of resources not being available for other purposes. The framework sets out the series of assessments to be made, distinguishing points at which value judgements feed into the evaluation, and the implications of alternative judgements. These assessments reflect the institutional arrangements of public bodies, for example, their funding, the outcomes they consider important and their relative valuations of these outcomes. By avoiding the use of an abstract 'societal perspective', the contribution of the framework is to inform multiple decision makers with different objectives and provide practical guidance on overall societal impact.
在大多数社会中，资源的分配是由在市场中行动的个人和通过某种形式的集体决策过程的政府来进行的。经济评估通过检查替代政策的资源需求和结果，为集体决策提供了一套工具。已经提倡了“社会视角”，但对其应包括的内容及其实际实施考虑得较少。本文提出了一个框架，用于评估成本和结果落在不同部门（例如卫生、刑事司法、教育）并涉及不同决策者的政策的经济效果。它通过考虑所有受影响的个人并反映归因于干预措施的结果如何与由于资源无法用于其他目的而导致的结果相权衡，扩展了第二面板在卫生和医学中的成本效益中开发的“影响清单”。该框架列出了要进行的一系列评估，区分了价值判断纳入评估的要点，以及替代判断的影响。这些评估反映了公共机构的机构安排，例如，他们的资金、他们认为重要的结果以及他们对这些结果的相对重视。通过避免使用抽象的“社会视角”，该框架的贡献在于为具有不同目标的多个决策者提供信息，并就整体社会影响提供实用指导。
