Hillner B E, Smith T J, Desch C E
Massey Cancer Center, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
J Hematother. 1993 Winter;2(4):501-6. doi: 10.1089/scd.1.1993.2.501.
Economic issues have a prominent place in the debate about reforming the U.S. health care system. If more rational allocations of health care resources are to occur, the principles of decision analysis and clinical economics will need to be understood and used to assess current and new technologies. This requires an explicit assessment of the costs and benefits of a health care intervention, defining the current standard intervention, and clarifying the perspective of the assessment (societal, patient, payer, or provider). Detailed cost accounting of resources is optimal in contrast to costs or charges. These principles were included in 1992 proposed Canadian guidelines for using economic evaluations for adoption of new technologies. Such guidelines provide further impetus for the economic assessment of phase III clinical trials. When applied to peripheral blood progenitor cells, future studies should assess the incremental benefits of the strategy using the progenitor cells, not just the cost savings compared to traditional autologous bone marrow transplantation.
经济问题在美国医疗保健系统改革的辩论中占据显著地位。若要实现医疗保健资源更合理的分配，就需要理解并运用决策分析和临床经济学原理来评估现有技术和新技术。这需要对医疗保健干预措施的成本和效益进行明确评估，界定当前的标准干预措施，并阐明评估的视角（社会、患者、支付方或提供者）。与成本或收费相比，对资源进行详细的成本核算最为理想。这些原则被纳入了1992年加拿大提出的关于采用新技术的经济评估指南中。此类指南为III期临床试验的经济评估提供了进一步的推动力。当应用于外周血祖细胞时，未来的研究应评估使用祖细胞策略的增量效益，而不仅仅是与传统自体骨髓移植相比的成本节约。
