综述比较经济分析中的异质性,特别考虑美国的分散环境和以患者为中心的护理
Michael S Willis1, Andreas Nilsson2, Cheryl A Neslusan3
1The Swedish Institute for Health Economics (IHE), Lund, Sweden. michael.willis@ihe.se.
PharmacoEconomics
|March 8, 2025
概括
经济评估经常忽视患者的异质性,导致医疗保健决策不足. 这项研究发现,在美国的成本效益分析中,对患者偏好和非患者因素的考虑有限,阻碍了有效的资源配置和患者结果.
科学领域:
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 以患者为中心的护理需要考虑个体需求,但经济评估通常依赖于人口平均值.
- 异质性,或根据患者特征,保险公司政策和提供者实践的结果变化,对于准确的经济评估至关重要.
- 如果不考虑异质性,可能导致医疗保健支出效率低下,患者的治疗结果不理想.
研究的目的:
- 评估解决经济评估中异质性的工具和方法.
- 检查美国成本效益研究中如何处理异质性.
- 为更好地考虑美国经济评估中的异质性提供建议.
主要方法:
- 对美国医疗保健环境的异质性分类学进行了审查和调整.
- 总结了处理经济评估中异质性的方法.
- 分析了来自塔夫斯医疗中心成本效益分析注册表 (2015-2022) 的数据,以评估美国成本效益研究中的子组分析实践.
主要成果:
- 小组分析很少进行,主要关注临床因素 (例如年龄,疾病严重程度).
- 在85项研究中,只有2项考虑了非患者因素,没有一个考虑了患者的偏好.
- 三分之一的研究显示,当分层时,成本效益比率在50%以上变化,但基本上没有包含/排除子组的理由.
结论:
- 尽管有可用的方法,但异质性在美国的成本效益研究中未得到充分利用,特别是在患者偏好和非患者因素方面.
- 解决异质性对于防止有缺陷的市场准入决策,改善患者的治疗结果和提高经济效率至关重要.
- 未来的工作应该完善分类学,并强调在经济评估中纳入异质性的重要性.
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