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经济评估应如何用于衡量医疗保健中的价值并确定优先事项?

How Should Economic Evaluation Be Used to Measure Value and Set Priorities in Health Care?

作者信息

Jayawardana Sahan, Mossialos Elias

机构信息

Health economist in the Department of Health Policy at the London School of Economics and Political Science in England.

Professor of health policy and the director of LSE Health at the London School of Economics and Political Science in England.

出版信息

AMA J Ethics. 2021 Aug 1;23(8):E613-618. doi: 10.1001/amajethics.2021.613.

Abstract

Novel interventions that are effective and safe but costly suggest the importance of questions about value, accessibility, and affordability. Economic evaluation is one useful tool that health care systems draw upon to help make investment decisions and set priorities. But translating results from economic evaluations into actionable insights about a novel intervention's value remains elusive, given ethical and practical complexities. This article illuminates 5 key factors to consider in interpretating economic evaluations of novel interventions: the health care decision problem, the design and structure of the mathematical model, characterization of uncertainty, awareness of health outcome measure limitations, and the contrast between optimal decision-making conditions and real-world decision-making conditions.

摘要

有效且安全但成本高昂的新型干预措施凸显了有关价值、可及性和可负担性问题的重要性。经济评估是医疗保健系统用以辅助做出投资决策和确定优先事项的一项有用工具。然而,鉴于伦理和实际方面的复杂性,将经济评估结果转化为关于新型干预措施价值的可操作见解仍然困难重重。本文阐明了在解读新型干预措施的经济评估时需要考虑的5个关键因素:医疗保健决策问题、数学模型的设计与结构、不确定性的特征描述、对健康结果测量局限性的认识,以及最优决策条件与现实世界决策条件之间的对比。

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