Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA.
Prioritize Consulting, Vancouver, Canada.
BMC Health Serv Res. 2019 Aug 13;19(1):560. doi: 10.1186/s12913-019-4405-6.
Implementing adequate strategies to assess the value of health services plays a central role in the effort to deal with the financial pressures faced by health care systems worldwide. This study aimed to understand which approaches to value assessment have been used in developed countries.
We conducted a rapid review and a gray literature search to identify value assessment frameworks. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. In addition, we developed an interpretive classification system to make sense of existing approaches.
One thousand one hundred seventy-six references were identified and 38 papers were selected for full-review. Among these 38 articles, 22 distinct approaches to assess value of health care interventions were identified and classified according to four points: 1) use of single or multiple considerations to base value estimates; 2) use of disease-specific or generic criteria; 3) reliance on process-based or outcomes-based consideration; and 4) type of input and evidence considered.
The contextual nature of value assessment in health care becomes evident with the diversity of existing approaches. Despite the predominance of cases relying on the Incremental cost-effectiveness ratio as the measure of value, this approach has not been sufficient to meet the needs of decision-makers. The use of multiple criteria has become more and more important, as well as the consideration of patient-reported measures. Considerations of costs are not always explicit and consistent.
实施充分的策略来评估卫生服务的价值在应对全球卫生保健系统面临的财务压力的努力中起着核心作用。本研究旨在了解发达国家使用了哪些方法来评估价值。
我们进行了快速审查和灰色文献搜索，以确定价值评估框架。我们采用了两阶段筛选过程来识别现有方法并对类似框架进行聚类。此外，我们开发了一种解释性分类系统来理解现有方法。
确定了 1176 个参考资料，并选择了 38 篇全文进行审查。在这 38 篇文章中，确定了 22 种不同的评估医疗干预措施价值的方法，并根据以下四个方面进行了分类：1）使用单一或多种考虑因素来确定价值估计；2）使用特定疾病或通用标准；3）依赖基于过程或基于结果的考虑因素；4）考虑的输入和证据类型。
医疗保健中价值评估的背景性质随着现有方法的多样性而变得明显。尽管基于增量成本效益比的方法作为价值衡量标准的情况居多，但这种方法还不足以满足决策者的需求。使用多种标准变得越来越重要，同时也考虑了患者报告的措施。成本的考虑并不总是明确和一致的。
