DiStefano Michael J, Levin Jonathan S
AMA J Ethics. 2019 Aug 1;21(8):E679-685. doi: 10.1001/amajethics.2019.679.
Using cost-effectiveness analysis (CEA) to inform prescribing can promote equitable drug access from a utilitarian perspective. Some theorists of equity, such as Rawls or Powers and Faden, however, would not consider CEA as promoting equity, as they endorse nonutilitarian theories of equity. Novel advances in CEA methodology seek to integrate broader equity concerns but may raise transparency concerns. We argue that incorporating CEA into qualitative multi-criteria decision analysis to inform prescribing decisions could promote equity more effectively and transparently than using CEA alone. Such applications should be implemented, along with recommendations, at the health system level rather than be carried out by individual clinicians alone.
使用成本效益分析（CEA）来指导处方开具，从功利主义角度来看，可以促进药物的公平可及性。然而，一些公平理论学家，如罗尔斯或鲍尔斯和法登，不会认为CEA能促进公平，因为他们支持非功利主义的公平理论。CEA方法的新进展试图纳入更广泛的公平考量，但可能会引发透明度方面的问题。我们认为，将CEA纳入定性多标准决策分析以指导处方决策，可能比单独使用CEA更有效地、更透明地促进公平。此类应用应与相关建议一起，在卫生系统层面实施，而不是仅由个体临床医生来执行。
