Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.
Division of Biology and Public Health, Mokwon University, Daejeon, South Korea.
J Altern Complement Med. 2021 Jan;27(1):58-65. doi: 10.1089/acm.2020.0359. Epub 2020 Nov 2.
South Korea is the first Asian country to adopt health technology assessment (HTA) as a tool to support decision-making concerning pricing and reimbursement of drugs in 2007. Korean traditional medicines have been continuously marginalized in the modern paradigm of evidence-based medicine. To nurture Korean medicines, clinical practice guidelines for Korean medicines have been developed through government-led initiatives, and HTAs have been applied for the National Health Insurance coverage of Korean medicines. In this study, 27 diseases were selected for analyzing the evidence development of both clinical and economic values of Korean medicines. To investigate the in application of HTA in Korean medicines, reports on the cost-effectiveness analysis project comprising 27 Korean medical interventions were reviewed. All the selected studies were trial-based economic appraisals and their effectiveness was estimated with a subjective judgment tool, such as the quality of life measurement or visual analog scale. This study reconfirmed the limitations of Korean medicines, which included a short observation period, nonrandomized controlled trials, small sample size, subjective assessment for efficacy, selection bias, large uncertainty, and lack of evidence. Priorities should be placed on establishing the clinical evidence of Korean medicines, which will serve as the base for expanding the health coverage of Korean medicines and improving satisfaction and reliability of oriental medicines in Korea's health care system. Furthermore, the need to nurture the institutional environment in which both oriental and Western medicines can collaborate in Korea should be emphasized.
韩国是 2007 年第一个将卫生技术评估（HTA）作为支持药品定价和报销决策工具的亚洲国家。韩国传统药物在基于证据的现代医学范式中不断被边缘化。为了培育韩国药物，政府主导制定了韩国药物临床实践指南，并将 HTA 应用于韩国药物的国家健康保险覆盖范围。在这项研究中，选择了 27 种疾病来分析韩国药物的临床和经济价值的证据开发情况。为了调查 HTA 在韩国药物中的应用，审查了包含 27 种韩国医疗干预措施的成本效益分析项目报告。所有选定的研究都是基于试验的经济评估，其有效性是用生活质量测量或视觉模拟量表等主观判断工具来估计的。这项研究再次证实了韩国药物的局限性，包括观察期短、非随机对照试验、样本量小、疗效的主观评估、选择偏倚、大不确定性和缺乏证据。应优先建立韩国药物的临床证据，这将为扩大韩国药物的健康保险覆盖范围以及提高韩国医疗体系中东方药物的满意度和可靠性奠定基础。此外，还应强调培育韩国东西方药物能够合作的制度环境的必要性。
