Gabriel S E
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
J Rheumatol. 1995 Jul;22(7):1412-4.
Using misoprostol prophylaxis as an example, many of the methods employed in economic analyses that incorporate mathematical models were described. These included: decision analysis, cost effectiveness analysis (including incremental cost effectiveness analysis), one-way, multi-way, and probabilistic sensitivity analysis, and the estimation of quality adjusted life years for use in cost utility analysis. In the case of misoprostol prophylaxis, the cost effectiveness analysis demonstrated that, compared to the no prophylaxis alternative, prophylaxis cost an extra $650, on average, for every additional ulcer prevented, and was potentially cost saving for some high risk groups. The cost utility analysis demonstrated that prophylaxis resulted (on average) in modest additional costs and no additional quality of life benefits. Sensitivity analysis demonstrated that, at worst, prophylaxis reduced quality of life; at best, the incremental cost effectiveness ratio was $9333 for each quality adjusted life-year gained by prophylaxis compared to no prophylaxis. The results of the cost utility analysis also showed that prophylaxis may be cost saving in high risk groups, confirming the results of the cost effectiveness analysis. Finally, and perhaps most importantly, this analysis illustrated the importance of incorporating measures of health related quality of life into economic evaluation.
以米索前列醇预防为例，描述了经济分析中采用数学模型的许多方法。这些方法包括：决策分析、成本效益分析（包括增量成本效益分析）、单向、多向和概率敏感性分析，以及用于成本效用分析的质量调整生命年的估计。在米索前列醇预防的案例中，成本效益分析表明，与不进行预防的方案相比，预防措施平均每多预防一例溃疡要额外花费650美元，并且对一些高危人群可能具有成本节约效果。成本效用分析表明，预防措施（平均）导致适度的额外成本，且未带来额外的生活质量改善。敏感性分析表明，最坏的情况是预防措施降低了生活质量；最好的情况是，与不进行预防相比，预防措施每获得一个质量调整生命年的增量成本效益比为9333美元。成本效用分析的结果还表明，预防措施在高危人群中可能具有成本节约效果，这证实了成本效益分析的结果。最后，也许最重要的是，该分析说明了将健康相关生活质量指标纳入经济评估的重要性。
