谈判临床实践指南:医生在实施和配额化高成本囊性纤维化治疗方面的经验
Audun Brendbekken1, Ole F Norheim1, Frode Lindemark2
1Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 29, 5009, Bergen, Norway.
Social science & medicine (1982)
|June 15, 2025
概括
临床医生发现很难停止囊性纤维化药物elexacaftor/tezacaftor/ivacaftor (Kaftrio) 由于感知到的有效性,即使不确定结果. 他们优先考虑提供治疗而不是拒绝治疗,从而影响了指南的实施.
科学领域:
- 卫生经济学 卫生经济学
- 临床实践指南 临床实践指南
- 罕见疾病治疗方法 罕见疾病治疗方法
背景情况:
- 医疗保健资源的限制需要床边配给.
- 高成本,证据不确定的罕见病治疗方法使分配决策复杂化.
- 临床实践指南旨在通过资格标准标准化配给.
研究的目的:
- 调查针对特定囊性纤维化治疗的临床实践指南的现实实施情况.
- 为健康经济学和优先设定文献贡献经验和理论见解.
- 分析临床医生在面对高成本,不确定的治疗时如何制定指南.
主要方法:
- 使用18个深度访谈进行的定性研究.
- 对面试数据进行反思性主题分析.
- 借鉴政策制定理论和临床决策文献.
主要成果:
- 临床医生认为elexacaftor/tezacaftor/ivacaftor (Kaftrio) 是非常有效的,这使得中止具有挑战性.
- 临床医生优先考虑治疗,根据不确定的资格适应指导方针解释.
- 开发了一个模型来解释治疗效应如何在不同知识领域进行谈判.
结论:
- 临床医生可以制定指导方针,以有利于治疗,特别是对于被认为有效的疗法.
- 了解治疗效果的谈判对于管理高成本的基因疗法至关重要.
- 这项研究提供了对医疗保健公平透明优先设定机制的见解.
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