Jönsson B
Stockholm School of Economics, Sweden.
Soc Sci Med. 1997 Aug;45(4):597-604. doi: 10.1016/s0277-9536(96)00399-1.
This paper reviews the use of economic evaluations in the Swedish health care system. The most important actors are defined and examples are given how economic evaluations have played a role in the decision making process. The introduction of extracorporal shock-wave lithotripsy (ESWL) is used as an example on how economic evaluation was used for recommendations to the county councils to adopt this technology. Mammography is used as an example of how the evaluation is used in the political process following an initiative in the parliament. A study of the cost-effectiveness of hypertension treatment illustrates how economic evaluations are included as part of a medical technology assessment by SBU, the Swedish Council on Technology Assessment in Health Care. The role of economic evaluations for drug reimbursement and pricing is also reviewed. The main conclusions are that economic evaluations are one of several factors influencing a decision making process that have a strong strive for consensus. It is thus difficult to make a definitive statement of the contribution of such study to the outcome of the decision making process, and there is no evidence that the evaluation was the decisive factor. However, a number of changes in the way resources are allocated in the Swedish health care system speaks for an increasing role for such studies in the future. The county councils are identified as the main target for economic evaluations, and SBU has a key role in supplying the county councils with high quality assessment of new and old technologies.
本文回顾了瑞典医疗保健系统中经济评估的应用情况。文中定义了最重要的行为主体，并举例说明了经济评估在决策过程中所发挥的作用。以体外冲击波碎石术（ESWL）的引入为例，阐述了经济评估如何用于向郡议会提出采用该技术的建议。以乳房X线摄影为例，说明在议会发起一项倡议后，评估如何在政治进程中得到应用。一项关于高血压治疗成本效益的研究表明，瑞典医疗技术评估委员会（SBU）如何将经济评估纳入医疗技术评估的一部分。文中还回顾了经济评估在药品报销和定价方面的作用。主要结论是，经济评估是影响决策过程的若干因素之一，决策过程强烈追求达成共识。因此，很难确切说明此类研究对决策过程结果的贡献，而且没有证据表明评估是决定性因素。然而，瑞典医疗保健系统资源分配方式的一些变化表明，此类研究在未来将发挥越来越大的作用。郡议会被确定为经济评估的主要对象，而SBU在为郡议会提供对新技术和旧技术的高质量评估方面发挥着关键作用。
