在英格兰,基于价值的精神卫生服务委托:使用多标准决策分析的可行性研究
Pamela Gongora-Salazar1, Rafael Perera2, Apostolos Tsiachristas3
1Inter-American Development Bank, Health, Nutrition and Population Division, Washington, DC, USA.
概括
多标准决策分析 (MCDA) 评估了两项精神病早期干预 (EIP) 服务. 牛津郡EIP表现出优越的金钱价值,这是由于成本降低和减少健康不平等所推动的.
科学领域:
- 卫生经济学 卫生经济学
- 心理健康服务研究 心理健康服务研究
- 决策分析 决策分析
背景情况:
- 基于价值的医疗保健是全球优先事项,但缺乏关于心理健康服务的价值和金钱价值的强有力的证据,包括各种价值元素和公共偏好.
- 精神病早期干预 (EIP) 服务对于改善结果至关重要,需要有效的资源配置.
研究的目的:
- 为了证明应用多标准决策分析 (MCDA) 来评估英格兰两个EIP服务的金钱价值.
- 为评估心理健康服务投资提供一个系统的,以证据为基础的框架.
主要方法:
- 采用多标准决策分析 (MCDA) 方法来评估英格兰东南部的两个EIP服务:牛津郡 (EIP-Oxf) 和白金汉郡 (EIP-Bucks).
- 评估纳入了五个价值元素:生命年数,生命质量 (复发时间),患者经验 (退出率),健康不平等 (时间到复发差异) 和平均年度成本.
- 性能指标的估计是使用一般化的线性模型和1127名患者的电子健康记录上的倾向性得分匹配. 概率灵敏度分析评估了强度.
主要成果:
- 与EIP-Bucks (0.552) 相比,EIP-Oxf的总体MCDA得分较高 (0.563).与EIP-Bucks (0.552) 相比,EIP-Oxf的总体MCDA得分更高.
- 对于EIP-Oxf,EIP-Bucks的每英价值比较高,每单位价值的成本比为10,438英,而EIP-Oxf的每单位价值比为12,655英.
- 这些结果主要归因于EIP-Oxf每名患者平均年度成本较低,以及减少了健康不平等.
结论:
- 多标准决策分析 (MCDA) 提供了一种全面和系统的方法来评估心理健康服务的金钱价值.
- 这种方法解决了现有的配给框架的局限性,并支持基于证据的当地决策.
- 在医疗保健资源分配和评估方面,MCDA方法具有更广泛的应用潜力.
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