Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, 490 Illinois Street, Rm 32M, San Francisco, CA, 94158, USA.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Pharmacoeconomics. 2022 May;40(5):489-495. doi: 10.1007/s40273-022-01131-z. Epub 2022 Mar 3.
A formal evaluation of the health equity impact of a new intervention is hardly ever performed as part of a health technology assessment to understand its value. This should change, in our view. An evidence-based quantitative assessment of the health equity impact can help decision makers develop coverage policies, programme designs, and quality initiatives focused on optimizing both total health and health equity given the treatment options available. We outline the conceptual basis of how a new intervention can impact health equity and adopt distributional cost-effectiveness analysis based on decision-analytic models to assess this quantitatively, using a newly US FDA-approved drug for Alzheimer's disease (aducanumab) as an example. We argue that gaps in the evidence base for the new intervention, for example, due to limited clinical research participation among racial and ethnic minority groups, do not preclude such an evaluation. Understanding these uncertainties has implications for fair pricing, decision making, and future research. If we are serious about population-level decision making that not only is focused on improving total health but also aims to improve health equity, we should consider routinely assessing the health equity impact of new interventions.
通常情况下，在进行健康技术评估以了解其价值时，很少会对新干预措施的公平性影响进行正式评估。我们认为，这种情况应该改变。基于证据的公平性影响定量评估可以帮助决策者制定覆盖政策、规划设计和质量倡议，以便在现有治疗方案的基础上，优化整体健康和公平性。我们概述了新干预措施如何影响健康公平的概念基础，并采用基于决策分析模型的分布成本效益分析来对此进行定量评估，以最近获得美国 FDA 批准用于治疗阿尔茨海默病的药物（aducanumab）为例。我们认为，新干预措施的证据基础存在差距，例如，由于少数族裔在临床研究中的参与度有限，并不排除这种评估。了解这些不确定性对公平定价、决策和未来研究都具有重要意义。如果我们认真对待以提高整体健康为目标、同时也旨在改善公平性的人群决策，我们应该考虑常规评估新干预措施的公平性影响。
