Weinstein M C, Siegel J E, Gold M R, Kamlet M S, Russell L B
Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass., USA.
JAMA. 1996 Oct 16;276(15):1253-8.
To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations.
The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS).
The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users.
The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists.
The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the ¿rule of reason,¿ balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.
制定基于共识的成本效益分析（CEA）实施建议。本文是一个系列的三篇文章中的第二篇，描述了构成参考案例分析的建议依据、为指导有助于社会资源分配决策的CEA而制定的一套做法，以及这些建议的内容。
健康与医学成本效益小组由美国公共卫生服务局（PHS）召集，是一个在CEA、临床医学、伦理学和健康结果测量方面具有专业知识的非联邦小组。
该小组审查了CEA的理论基础、当前做法以及分析中使用的替代方法。建议尽可能基于理论制定，但会受到伦理和实际考虑因素以及用户需求的影响。
该小组通过两年半的讨论制定了建议。向联邦政府方法学家、卫生机构官员和学术方法学家征求了对小组工作组编写的初稿的意见。
该小组的方法学建议涉及：（1）成本效益（C/E）比率分子和分母中的组成部分；（2）测量C/E比率分子中的资源使用情况；（3）对C/E比率分母中的健康后果进行估值；（4）估计干预措施的效果；（5）纳入时间偏好和贴现；以及（6）处理不确定性。建议遵循“合理规则”，平衡一种做法带来的负担与其对一项研究的重要性。如果研究人员在CEA中遵循一套标准方法，研究的质量、可比性及其最终效用可以得到很大提高。
