评估成本效益的决策框架 考虑到以前的非最佳决策
Doug Coyle1,2, David Glynn3, Jeremy D Goldhaber-Fiebert4,5
1School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
概括
不同的经济评估框架会影响医疗保健补偿决策. 规范性框架通过只涵盖最佳治疗方法来最大限度地提高人口健康,而积极主义框架在退出资金是不可行的情况下提供了切实可行的替代方案.
科学领域:
- 卫生经济学 卫生经济学
- 决策分析 决策分析
- 卫生技术评估 卫生技术评估
背景情况:
- 传统的经济评估旨在确定一个人群的最佳治疗方案.
- 当前的医疗保健系统往往涵盖多种技术,适用于异构的患者群体.
- 这使得在现有的补偿格局中对新技术的评估变得复杂.
研究的目的:
- 探索不同决策框架对经济评估的影响.
- 评估这些框架如何影响新医疗技术的补偿建议.
- 分析对人口健康的后果和所需的降价.
主要方法:
- 考虑三个决策框架:规范,当前和积极主义.
- 使用模拟的概率马尔科夫模型.
- 将模型应用于慢性渐进性疾病.
主要成果:
- 不同的框架会产生不同的报销建议.
- 框架选择影响了人口健康结果.
- 退款决定会影响采用新技术所需的降价.
结论:
- 仅涵盖最佳治疗 (规范框架) 才能最大限度地提高总体人口健康.
- 当取消现有技术的资金不是一个选择时,正证主义框架是最相关的.
- 实证主义框架为决定新技术覆盖范围提供了一个实际的方法.
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