评估扩大与限制第一线治疗选择的政策:成本效益分析框架
Boshen Jiao1, Josh J Carlson2, Louis P Garrison2
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA; Department of Global Health and Population, Havard T.H. Chan School of Public Health, Boston, MA, USA.
概括
这项研究引入了一个新的成本效益框架来评估一线癌症治疗政策. 该框架考虑了患者的偏好和实施成本,为医疗保健支付者提供了更现实的评估.
科学领域:
- 卫生经济学 卫生经济学
- 临床决策 临床决策
- 卫生政策分析 卫生政策分析
背景情况:
- 医疗保健支付人经常限制人们获得新的,昂贵的第一线治疗.
- 传统的成本效益分析可能无法捕捉诸如治疗效果异质性和患者偏好等复杂因素.
研究的目的:
- 开发一个先进的成本效益分析框架.
- 结合现实世界的因素,如异质的治疗效果,内源性选择和多样化的患者偏好.
- 评估扩大或限制第一线治疗选择的政策.
主要方法:
- 引入了一种新的增量成本效益比率 (ICER) 度量,比较扩展与限制选择集 (CS).
- ICER ((CS) 考虑了受异质效应和实施成本影响的治疗选择.
- 使用对转移性激素敏感前列腺癌的阿比拉酸盐加上普雷尼松 (AAP) 的回顾性分析来说明框架.
主要成果:
- 对于ADT + AAP与ADT和ADT + docetaxel的传统ICER分别为104,269美元和206,324美元/QALY.
- 包括ADT + AAP在内的扩展CS的 ICER ((CS) 建议价格为123,179美元/QALY.
结论:
- 开发的框架为决策者提供了与政策相关的工具.
- 它可以更全面地评估替代第一线治疗政策的成本效益.
- 促进扩大与限制患者和医生治疗选择的评估.
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