Centre for Health Economics, University of York, York, UK.
Adelphi Values, Bollington, Cheshire, UK.
Med Decis Making. 2022 Jan;42(1):17-27. doi: 10.1177/0272989X211016427. Epub 2021 May 27.
Policy evaluations often focus on ex post estimation of causal effects on short-term surrogate outcomes. The value of such information is limited for decision making, as the failure to reflect policy-relevant outcomes and disregard for opportunity costs prohibits the assessment of value for money. Further, these evaluations do not always consider all relevant evidence, other courses of action, or decision uncertainty.
In this article, we explore how policy evaluation could better meet the needs of decision making. We begin by defining the evidence required to inform decision making. We then conduct a literature review of challenges in evaluating policies. Finally, we highlight potential methods available to help address these challenges.
The evidence required to inform decision making includes the impacts on the policy-relevant outcomes, the costs and associated opportunity costs, and the consequences of uncertainty. Challenges in evaluating health policies are described using 8 categories: 1) valuation space; 2) comparators; 3) time of evaluation; 4) mechanisms of action; 5) effects; 6) resources, constraints, and opportunity costs; 7) fidelity, adaptation, and level of implementation; and 8) generalizability and external validity. Methods from a broad set of disciplines are available to improve policy evaluation, relating to causal inference, decision-analytic modeling, theory of change, realist evaluation, and structured expert elicitation.
The targeted review may not identify all possible challenges, and the methods covered are not exhaustive.
Evaluations should provide appropriate evidence to inform decision making. There are challenges in evaluating policies, but methods from multiple disciplines are available to address these challenges.
Evaluators need to carefully consider the decision being informed, the necessary evidence to inform it, and the appropriate methods.[Box: see text].
政策评估通常侧重于短期替代结果的事后因果效应估计。由于未能反映政策相关结果且忽略机会成本，此类信息对于决策而言价值有限，无法评估资金的使用效益。此外，这些评估并不总是考虑所有相关证据、其他行动方案或决策不确定性。
本文探讨了如何使政策评估更好地满足决策需求。我们首先定义了为决策提供信息所需的证据。然后，我们对评估政策面临的挑战进行文献综述。最后，我们强调了可能有助于解决这些挑战的潜在方法。
为决策提供信息所需的证据包括对政策相关结果的影响、成本和相关机会成本，以及不确定性的后果。使用 8 个类别描述了评估卫生政策所面临的挑战：1）估值空间；2）对照；3）评估时间；4）作用机制；5）效果；6）资源、限制因素和机会成本；7）保真度、适应性和实施水平；8）概括性和外部有效性。来自多个学科的方法可用于改进政策评估，包括因果推断、决策分析建模、变革理论、实际评估和结构化专家 elicitation。
有针对性的综述可能无法识别所有可能的挑战，涵盖的方法也不是详尽无遗的。
评估应提供适当的证据来为决策提供信息。评估政策存在挑战，但有多种学科的方法可用于解决这些挑战。
评估人员需要仔细考虑所依据的决策、为其提供信息所需的证据以及适当的方法。[方框：见正文]。
