英国NICE卫生技术评估流程的决策转化机制及启示

通过对英国国家健康与临床优化研究院(NICE)从2000年到2020年20年间针对卫生技术的评估方法、评估流程及评估结果及转化推广情况等进行详细梳理介绍.从加快建立我国独立的卫生技术评估机构、多元化HTA评估方法、完善评估主题遴选流程、建立健全评估委员会制度、评估流程的进一步优化、确保卫生技术评估证据来源的同步性和协调性等方面,为我国卫生技术的发展和进一步完善提供参考和借鉴.     

泰国卫生技术评估机制建设现状及启示

文章介绍了泰国卫生技术评估的发展历程、具体应用、机构建设,以及运行机制和规范化评估工具。启示我国在国家级HTA机构发展良好的基础上,应鼓励各地区设立和发展HTA机构;建立完整规范的决策转化机制;逐步建设形成适合我国的卫生技术评估规范化工具;建设HTA数据共享平台,以不断提升我国卫生技术评估能力。     

西班牙卫生技术评估的发展应用及启示

西班牙卫生技术评估的发展在全球是成功经验之一,经过多年发展,西班牙已经建立了较为成熟的卫生技术评估体系。通过文献复习,总结了西班牙卫生技术评估工作的基本特征、地位、决策过程、医院卫生技术评估发展的相关经验。提出了将HTA作为政府卫生政策的重要工具,加强卫生技术评估协作网建设,大力发展医院卫生技术评估,建立立体全面的卫生技术评估协作体系等政策建议。     

卫生技术评估认知与需求现况调查

目的 了解浙江省卫生技术及管理人员对卫生技术评估(HTA)的认知和需求,为进一步开展HTA工作提供建议.方法 采用问卷调查与访谈相结合的方法对3家医院,1家公共卫生机构,8家卫生行政机构的102位运用HTA结果的潜在使用者和22位决策者进行了调查.结果 被调查者认为卫生技术相关政策法规在卫生技术信息来源最为重要,卫生技术临床疗效在用于决策的卫生技术相关信息中最为重要,相关研究质量太差是影响卫生技术评估的最大障碍.结论 浙江省卫生技术及管理人员对于HTA有一定的认知与需求,但关注度不够,针对遇到的障碍提出了HTA进一步发展的建议.     

德国卫生技术评估决策转化路径及方法探析

德国与我国有着相似医疗保障体系背景,并且已经形成以国家层面三大卫生技术评估(Health Technology Assessment,HTA)机构为主的严谨的HTA管理流程和高效的决策转化路径,是全球基于HTA进行卫生领域循证决策的典型代表。本文通过文献研究和实地调研,分析梳理了德国HTA应用及其决策转化的路径和方法,最终结合我国现阶段HTA决策转化面临的问题和挑战,有针对性地提出了几条促进我国HTA决策转化的启示性建议。     

CT卫生技术评估报告分析及启示

目的为我国开展影像学诊断设备卫生技术评估（HTA）提供方法学参考。方法检索国际卫生技术评估机构网站,对纳入的CT HTA报告进行结构化信息提取和分析。结果共纳入4个国家6家机构的24篇HTA报告。其中,快速卫生技术评估12篇,全面卫生技术评估12篇。评估核心维度为有效性、经济性和安全性。纳入报告均采用了文献综述分析,部分针对重大决策的HTA进行了Meta分析、成本-效果分析和预算影响分析。 结论可为我国CT等影像学诊断设备技术评估提供参考,提高我国大型医疗设备治理决策的科学化水平。     

加拿大卫生技术评估机构研究:以加拿大药物和卫生技术局为例

加拿大卫生技术评估机构在世界范围内具有重要的影响力。加拿大药物和卫生技术局(CADTH)作为加拿大独立的、非营利性、国家级的卫生技术评估(HTA)研究机构,依靠联邦以及州政府的财政支持,在卫生技术评估的主题选取、评估质量提升、成果传播以及新技术评估等方面都有着较为成熟的经验。文章通过分析和研究CADTH的成功经验,从加大政府投入、提升评估质量以及建立新兴技术预警机制三方面,对我国卫生技术评估机构的发展和完善提出一些政策建议。     

人工晶体卫生技术评估方法学分析及启示

目的通过分析国际典型的人工晶体卫生技术评估(HTA)案例，为我国开展相关评估提供方法学参考。方法通过范围综述方法检索国际卫生技术评估网络成员HTA机构网站，对纳入的人工晶体HTA报告进行结构化信息提取和分析。结果共纳入3个国家5家HTA机构的15篇HTA报告，其中，rHTA 12篇，fHTA 3篇。HTA评估的核心维度为安全性和有效性,支持医保部门的研究需要纳入经济性维度。对现有研究证据开展系统分析是当前主流方法，但针对重大决策的HTA一般会进行本土化数据收集和分析。结论可为我国开展人工晶体HTA的总体设计、评估问题、评估维度、工具方法、具体指标等选择提供方法学参考，从而助力我国高值耗材治理决策制定。     

英国和瑞典卫生技术评估的发展

英国和瑞典开展卫生技术评估较为成熟。对两国卫生技术评估的发展历程和主要机构进行回顾．希望从中汲取经验,进而对我国卫生技术评估的的发展起借鉴作用。     

卫生技术评估审慎评议的概念与启示

对卫生技术评估(health technology assessment,HTA)审慎评议的理论与实践进行系统介绍,以期促进中国HTA审慎评议环境及体制机制建设,并为医疗保险准入等医疗决策过程的完善提供参考.     

新加坡、韩国和日本卫生技术评估发展概况及启示

主要对新加坡、韩国和日本3国卫生技术评估的发展概况进行综述,从而为我国卫生技术评估的发展提供经验参考。     

Progress towards universal health coverage in BRICS: translating economic growth into better health

Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – represent some of the world’s fastest growing large economies and nearly 40% of the world’s population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.     

Impact of BRICS’ investment in vaccine development on the global vaccine market

Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – have made considerable progress in vaccine production, regulation and development over the past 20 years. In 1993, all five countries were producing vaccines but the processes used were outdated and non-standardized, there was little relevant research and there was negligible international recognition of the products. By 2014, all five countries had strong initiatives for the development of vaccine technology and had greatly improved their national regulatory capacity. South Africa was then the only BRICS country that was not completely producing vaccines. South Africa is now in the process of re-establishing its own vaccine production and passing beyond the stage of simply importing, formulating and filling vaccine bulks. Changes in the public sector’s price per dose of selected vaccines, the global market share represented by products from specific manufacturers, and the attractiveness, for multinational companies, of partnership and investment opportunities in BRICS companies have all been analysed. The results indicate that the BRICS countries have had a major impact on vaccine price and availability, with much of that impact attributable to the output of Indian vaccine manufacturers. China is expected to have a greater impact soon, given the anticipated development of Chinese vaccine manufacturers in the near future. BRICS’ accomplishments in the field of vaccine development are expected to reshape the global vaccine market and accelerate access to vaccines in the developing world. The challenge is to turn these expectations into strategic actions and practical outcomes.     

美国、加拿大与澳大利亚的卫生技术评估

以美国、加拿大和澳大利亚为例,回顾了卫生技术评估发展历史、体系结构、参与各方以及对于卫生政策的影响.其对我国卫生技术评估的发展提供了可借鉴的经验.     

Towards Integrated Health Technology Assessment for Improving Decision Making in Selected Countries

Objectives

To assess the level of comprehensiveness of health technology assessment (HTA) practices around the globe and to formulate recommendations for enhancing legitimacy and fairness of related decision-making processes.