解决特定小组治疗效应以避免低效护理:统计和健康经济分析之间的冲突
Sopany Saing1, Gerjon Hannink2, H Amarens Geuzinge3
1Section of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Overijssel, The Netherlands.
概括
在成本效益分析中忽视患者子组差异导致了低于最佳的报销决策. 利用所有子组证据优化了健康干预措施的社会效益.
科学领域:
- 卫生经济学 卫生经济学
- 决策分析 决策分析
- 药物经济学 药物经济学
背景情况:
- 患者的异质性可以显著影响卫生干预措施的成本效益.
- 成本效益分析 (CEA) 可以反映或忽略这种异质性,从而影响报销决策.
研究的目的:
- 评估CEA中处理子组异质性的不同策略对偿还决策的影响.
- 确定合并子组证据的最佳方法,以最大限度地提高社会效益.
主要方法:
- 使用R中的马尔科夫模型进行的模拟研究分析了假设治疗与标准护理的成本效益.
- 对比了三个策略:忽视子组证据,以统计为导向的方法和使用所有子组证据.
- 场景的样本大小,子组比例,治疗有效性和基线死亡风险各不相同.
主要成果:
- 这种以统计为导向的策略往往导致了小组被忽视,除了在总样本大小的场景中.
- 在5万欧元/经质量调整的寿命年的支付意愿门下,与忽视子组证据相比,以统计为指导的策略显示了1.00的增量净健康益.
结论:
- 忽视或使用已知子组异质性的统计指导方法会导致低于最佳的报销决策.
- 特定子组的成本效益分析必须纳入所有有关子组差异的现有证据,以优化社会效益.
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