Drummond M, Cooke J, Walley T
Centre for Health Economics, University of York, Heslington, U.K.
Soc Sci Med. 1997 Aug;45(4):583-95. doi: 10.1016/s0277-9536(96)00398-x.
Although economic evaluation in health care has a long-standing tradition in the United Kingdom, very little is known about its impact on decision making, particularly following the introduction of the internal market. Since managed competition appears to be growing in popularity worldwide, the U.K. is an interesting case study, as the reforms are well underway and there have been a number of efforts to conduct and disseminate economic evaluations. In this paper the potential for using economic evaluation in health care decision making in the U.K. is discussed. Then its actual impact is assessed in two ways. First, two case studies are discussed, on heart transplantation and the use of pharmaceuticals in the management of labour in pregnancy. Second, new data from a recent survey of potential users of economic evaluations are presented, with the emphasis on exploring the reasons for the impact, or lack of impact, of economic results. It is concluded that the NHS reforms increase the potential for the use of economic evaluation. However, there is a need to increase decision makers' awareness of economic studies and to help them interpret study methodology and results. Although worries about validity of economic studies are one of the major barriers to their use, other important barriers relate to the multiple objectives being pursued, of which increased efficiency is just one, and the difficulties of freeing resources from existing services in order to divert them to more cost-effective treatments and programmes.
尽管医疗保健领域的经济评估在英国有着悠久的传统，但对于其对决策的影响却知之甚少，尤其是在引入内部市场之后。由于管理式竞争在全球范围内似乎越来越受欢迎，英国是一个有趣的案例研究对象，因为改革正在顺利进行，并且已经做出了一些开展和传播经济评估的努力。本文讨论了在英国医疗保健决策中使用经济评估的潜力。然后从两个方面评估其实际影响。第一，讨论了两个案例研究，分别是心脏移植和孕期分娩管理中药物的使用。第二，展示了最近对经济评估潜在用户进行调查的新数据，重点是探究经济结果产生影响或未产生影响的原因。得出的结论是，国民健康服务体系（NHS）改革增加了使用经济评估的潜力。然而，有必要提高决策者对经济研究的认识，并帮助他们解读研究方法和结果。尽管对经济研究有效性的担忧是其应用的主要障碍之一，但其他重要障碍涉及所追求的多个目标（提高效率只是其中之一），以及从现有服务中释放资源以将其转向更具成本效益的治疗和项目的困难。
