Jönsson B
Stockholm School of Economics, Sweden.
Scand J Gastroenterol Suppl. 1994;201:87-90. doi: 10.3109/00365529409105372.
Safety and efficacy are not the only parameters of interest for choice of medical technology--costs play an increasingly important role. There is a growing interest in 'value for money', which can be assessed by economic evaluation comparing the costs and consequences of alternative courses of action. A number of different economic evaluation methods may be used: cost-minimization (looking only at costs with no consideration of consequences); cost-effectiveness (in which a unidimensional clinical outcome is assessed, for example, life-years gained); cost-utility (measuring multidimensional outcomes, for example quantity and quality of life); and cost-benefit (where outcome is considered in monetary terms). A Swedish cost-of-illness study showed that the direct health care costs increased and the indirect cost (in terms of production loss) associated with treatment of peptic ulcer fell following the introduction of H2-receptor antagonists. In a study of reflux oesophagitis, omeprazole was shown to be more cost-effective than ranitidine. With omeprazole, the costs were lower and the effectiveness better than with the H2-receptor antagonist.
安全性和有效性并非选择医疗技术时唯一需要考虑的参数——成本正发挥着越来越重要的作用。人们越来越关注“性价比”，这可以通过经济评估来衡量，即比较不同行动方案的成本和结果。可以使用多种不同的经济评估方法：成本最小化（只考虑成本而不考虑结果）；成本效果分析（评估单一维度的临床结果，例如获得的生命年数）；成本效用分析（衡量多维度结果，例如生活质量和数量）；以及成本效益分析（将结果以货币形式考虑）。一项瑞典疾病成本研究表明，在引入H2受体拮抗剂后，消化性溃疡治疗的直接医疗成本增加，而与治疗相关的间接成本（以生产损失计算）下降。在一项反流性食管炎研究中，奥美拉唑被证明比雷尼替丁更具成本效益。使用奥美拉唑时，成本更低，效果比H2受体拮抗剂更好。
