Bodger K, Daly M J, Heatley R V, Williams D R
Division of Medicine, St. James's University Hospital, Leeds, UK.
Aliment Pharmacol Ther. 1996 Feb;10(1):55-60. doi: 10.1111/j.1365-2036.1996.tb00177.x.
In the prevailing climate of cost containment, doctors are increasingly expected to consider the economic consequences of treatment choices. Clinical (or medical) economics attempts to apply economic principles to the description and analysis of the costs of medical interventions, so as to identify how best to spend scarce health care resources. Such economic evaluations may assess the overall financial burden of a disease to society as a whole (macro-economics), or attempt to compare alternative treatment strategies for a specific clinical situation (micro-economics). In addition to expenditure on drugs and investigations (direct medical costs), economic studies may consider a variety of other costs. These include direct costs borne by patients (e.g. prescription charges, travel, food), indirect costs to society owing to lost productivity (resulting from morbidity or premature mortality) and even intangible costs which assign a monetary value to outcomes of disease such as pain, distress and anxiety. Four main types of economic analysis are in current use. Cost-minimization analysis attempts to identify the least expensive option in situations where there are a range of equally effective treatments for a given clinical condition, whereas cost-effectiveness analysis allows management strategies differing both in cost and efficacy to be compared. The cost-effectiveness of health care programmes targeting different disease states may also be compared using cost-utility analysis, in which health benefits are translated into a common utility-based unit of outcome, such as the Quality Adjusted Life Year (QALY). Cost-benefit analysis attempts to quantify health outcomes in monetary terms, so that the net result provides an assessment of value-for-money of health interventions. Gastrointestinal disorders are amongst the commonest of complaints, and considerable health care resources are consumed in treatment. Issues of cost-effectiveness are likely to assume increasing importance in gastroenterology because of the ever expanding range of drug choice, the increasing number of high cost treatments and the development of new therapeutic interventions.
在当前成本控制的大环境下，人们越来越期望医生在选择治疗方案时考虑其经济后果。临床（或医学）经济学试图将经济原则应用于医疗干预成本的描述和分析，以便确定如何最有效地利用稀缺的医疗资源。此类经济评估可评估某种疾病对整个社会的总体经济负担（宏观经济学），或尝试比较针对特定临床情况的不同治疗策略（微观经济学）。除了药物和检查费用（直接医疗成本）外，经济研究还可能考虑各种其他成本。这些成本包括患者承担的直接成本（如处方费、差旅费、伙食费）、因生产力损失给社会带来的间接成本（由发病率或过早死亡导致），甚至还包括对疼痛、痛苦和焦虑等疾病后果赋予货币价值的无形成本。目前主要使用四种经济分析类型。成本最小化分析试图在针对某一特定临床状况存在一系列同等有效治疗方法的情况下，找出成本最低的选择，而成本效益分析则允许对成本和疗效各异的管理策略进行比较。还可使用成本效用分析来比较针对不同疾病状态的医疗保健项目的成本效益，在这种分析中，健康效益被转化为基于通用效用的结果单位，如质量调整生命年（QALY）。成本效益分析试图用货币形式量化健康结果，以便最终结果能对健康干预措施的性价比进行评估。胃肠道疾病是最常见的疾病之一，治疗过程消耗了大量医疗资源。由于药物选择范围不断扩大、高成本治疗方法日益增多以及新治疗干预措施的发展，成本效益问题在胃肠病学领域可能会变得越来越重要。
