是时候重新考虑3%的折扣率了
1Deputy Director, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
概括
卫生技术评估 (HTA) 指南应将折扣率降至1.5-2%以上. 这种调整将提高对长期健康益处和药物定价动态的成本效益预测.
科学领域:
- 卫生经济学 卫生经济学
- 卫生技术评估 卫生技术评估
- 药物经济学 药物经济学
背景情况:
- 卫生技术评估 (HTA) 指南通常建议使用3%的实际年折扣率.
- 这种标准贴现率的适当性没有得到充分的检查.
- 折扣率对医疗保健的成本效益分析和资源分配决策有重大影响.
研究的目的:
- 确定高收入国家卫生技术评估的适当折扣率.
- 评估HTA中贴现率建议的理论基础和实际应用.
主要方法:
- 在PubMed.gov进行了两次文献搜索:一个是关于折扣率理论,另一个是关于HTA指导文件.
- 审查了21篇关于贴现率理论的文章,确定拉姆西方程和市场利率作为主要方法.
- 分析了来自32个高收入国家的HTA指南,以评估其推的折扣率和合理性.
主要成果:
- 拉姆西方程的方法考虑了纯粹的时间偏好,灾难性风险,财富效应和宏观经济风险,以及项目特定风险.
- 市场利率是另一种方法,反映机会成本.
- 大多数HTA指南 (22/32) 缺乏明确的理由;其他指南引用了市场利率 (8/32),一致性 (3/32) 或拉姆齐方程因子 (3/32).
结论:
- 经济指标下降表明,推的HTA折扣率应降至1.5-2%以上.
- 降低折扣率将提高具有长期效益的干预措施的预计成本效益.
- 此次调整还将更好地考虑长期药品定价动态,例如在市场独家权丧失后的降价.
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