用不同测量方法得到的效用值的比较

目的:比较用不同测量方法得到的效用值之间的差异。方法:采用不同测量方法同时对350例老年性黄斑变性的患者进行效用测量,把用不同测量方法得到的效用值的中位数作为相对标准效用值与各种效用值进行比较、方差分析、相关分析和曲线拟合。结果:用不同测量方法得到的效用值之间的差异和相关性大多具有显著意义,相对标准效用值与各种效用值的曲线方程也具有显著意义,但拟合度都不高。结论:对于相同的对象用不同测量方法得到的效用值是不同的,在没有绝对标准的情况下,本研究得到的结果可以作为用单一方法测量得到的效用值的修正参考。     

卫生领域中成本效用分析的应用

经济学研究的中心问题是资源的稀缺性和需求的无限性。为使有限的资源发挥最大的效益 ,就要在资源的分配中确保重点优先 ,同时发挥有限资源的利用效率。医疗卫生作为一种资源 ,在对各种卫生保健计划进行经济评价时 ,主要是分析成本和结果（效果）。而全面的经济评价应该从成本和结果两方面比较分析。卫生领域中经济学评价有四种 ,即成本效益分析、成本效果分析、成本效用分析、最小成本分析。这四种评价的技术特性见附表 :分析技术成本的测定结果的识别结果的测定最小成本分析货币在所有方向一致无成本 -效果分析货币单项指标,各方案相同有…     

成本效用分析原则及步骤

本文介绍了成本效用分析原则和成本效用分析的基本步骤，以及在执行项目成本效用分析时需注意的问题。     

心血管介入疗法的成本效用分析

采用队列研究,根据支架手术预后和转归建立国产和进口支架的Markov模型,进行成本一效用分析。结果显示,进口支架的累计效用和成本均高于国产支架,进口支架多获得一个QALY需要多支付的成本小于一倍人均GDP,进口支架仍具成本效用。建议医疗保险部门在设置最高限价的同时预设付费标准;随着经济发展,适当提高最高限价,或者按价格分段设置不同的支付比例,以获得更多的效用产出。     

效用指标的测量方法及其研究进展

健康产出一般很难用一个单一的效果指标进行测量。一项干预措施除了影响生存人年数以外，还会影响健康状况（即生命质量）。因此需要把对生命质量和数量的影响结合起来考虑，效用就具有这样的特点，主要包括质量调整生命年（QALYs)、等价健康年（HYEs）、伤残调整生命年（DALY）和伤残调整期望寿命（DALE）四个指标，其中质量调整生命年应用最广。但是，麦雷兹和甘富尼等人认为，QALYs可能与个体偏好不一致，建议使用HYEs这个产出指标。近近些年来世界卫生组织提倡使用后两个指标，本文概述了效用指标的测量方法及其研究进展。首先描述QALYs的测量方法，其次描述HYEs的测量方法，再次简单概述DALY和DALY，最后进行总结。提出建议。     

成本效用分析方法介绍

成本效用分析是项目经济评价的一种方法。在成本效用分析中，通过比较项目投入成本量和项目获得的质量调整生命年来衡量项目的效率。成本效用分析已广泛应用在卫生保健项目的经济评价中。     

乙肝疫苗接种成本-效用现状分析

应用成本-效用分析方法对我国乙肝疫苗接种方面应用研究进展作一分析。在知网/万方/维普平台对乙肝/卫生经济学评价/成本效用/成本效果/成本效益进行主题检索。从研究角度、研究区域、成本测算、效用指标、研究方法、敏感性与阈值等方面对文献进行对比分析。结果显示,本研究中纳入的文献共17篇,其中6篇文献提出了明确的研究角度;8个省份(直辖市)开展了乙肝疫苗接种的成本效用分析;绝大多数仅对疫苗接种费用进行了测算,14篇文献对成本进行3%的贴现;10篇文献使用了数学模型进行分析;9篇文献选取了失能调整生命年(DALY)),10篇选取了质量调整生命年(QALY)作为效用指标,其中13篇进行了效用值贴现;共14篇文章对结果进行了敏感性分析;3篇文献提出了阈值。国内尚未出现系统的乙肝疫苗接种的成本-效用分析研究,缺乏全面的地区性的研究。应加强乙肝疫苗接种方面的调查,完善研究规范与方法,为决策者选取经济有效,提高人群生命质量的策略提出可参考意见。     

癫痫综合干预成本-效用分析

目的 对癫痫综合十预的效果进行卫生经济学评价.方法 在河南省9个项目示范点对874例癫痫患者进行调查.以农村癫痫防治管理项目研究为依托,计算癫痫综合干预的成本,以伤残调整生命年(DALY)和质量调整生命年(QALY)为效用指标进行成本效用分析.结果 874例患者中,综合干预组(422例)人均损失8 58个DALY,获得27 95个QALY,获得1个QALY需付出的成本为2454 10元,挽救1个DALY需付出7995.40元;相对于无干预对照组(452例),综合干预组获得QALY所需成本减少,挽救1个DALY少投入21 73510元.结论 癫痫对社会、家庭、患者本人造成严重的经济损害,综合性干预可以更好地降低癫痫患者的疾病经济负担,具有较高的成本-效用收益,值得推广.     

以色列高血压干预计划的成本效用分析

在以色列疾病负担中,高血压、心脏病和中风所占比重非常大,其治疗费用也最为昂贵.为应对这一挑战,以色列实施了两项高血压控制计划(AHDC计划和IBPC计划).基于这两项干预计划的经验,以色列提出了一项可以与周边国家进行合作的全国性血压控制计划.该研究的目的是通过描述该计划实施的成本与效用情况来促进全国血压控制计划的实施.     

Cost effectiveness analysis of smoking cessation interventions

OBJECTIVE: To identify which smoking cessation interventions provide the most efficient use of health care resources at a population level. METHODS: Effectiveness data were obtained from a review of the international literature. Costs and effects of smoking cessation interventions were estimated from the perspective of the Australian Government. Treatment costs and effects were modelled using incremental cost-effectiveness ratios. Assumptions regarding effectiveness, resource use and costs were tested by sensitivity analysis. RESULTS: From the population perspective, telephone counselling appeared to be the most cost-effective intervention. Adding proactive forms of telephone counselling increased the effectiveness of pharmacotherapies at a low incremental cost and, therefore, this could be a highly cost-effective strategy. Bupropion appeared to be more cost effective than nicotine replacement therapy (NRT). Combined bupropion and NRT did not appear to be cost effective. CONCLUSIONS: General practitioners should be encouraged to refer patients to telephone quit lines and if prescribing pharmacotherapy consider the addition of telephone counselling. IMPLICATIONS: The results support greater investment in proactive forms of telephone counselling and more formal integration of pharmacotherapies with proactive telephone counselling services as cost-effective strategies for reducing population-level smoking rates.     

Cost effectiveness analysis of school based Mantoux screening for TB infection

OBJECTIVE: To assess the cost-effectiveness of adding school based Mantoux screening programs to the New South Wales current TB prevention strategy. METHOD: A decision analysis model compared the costs and consequences of screening strategies against the current no-screen strategy. Costs associated with screening and with treating future cases of TB were considered. Consequences considered were deaths and adult cases of TB prevented. The study was based on data from prevalence surveys conducted in 1992 and 1994 in Central and South Western Sydney, New South Wales. Screening strategies considered were screening all or only overseas born (OSB) 6 year olds and all or only OSB 14 year olds in school settings. RESULTS: Screening 14 year olds prevented more deaths and adult cases of TB than screening 6 year olds for a similar cost. For both age groups targeted screening of OSB children was more cost-effective than screening all children. Targeted screening of 14 year olds--the most cost effective option--cost $17,956 (costs and benefits discounted at 5%) per adult case prevented, equivalent to approximately $130,000 per life year saved. The cost-effectiveness ratios decline substantially if lower discount rates and less conservative assumptions are applied. CONCLUSION: Targeted screening was more cost effective than screening all children, however, there are ethical implications of targeting a group based on their origin of birth. IMPLICATIONS: As prevention and control of TB continues to be a high priority for NSW, the implications of a school based screening program should be seriously considered.     

Cost effectiveness of palivizumab in Spain: an analysis using observational data

Objectives  

To assess the cost effectiveness of palivizumab for prevention of severe respiratory syncytial virus (RSV) disease in high-risk infants in Spain, incorporating country-specific observational hospitalisation data.     

Cost effectiveness scenario analysis for a proposed trial of hormone replacement therapy

Whereas evaluation of resource implications and quality of life are often incorporated into assessments of health technology, the decision to undertake the assessment is still mostly driven by interests in the clinical outcomes alone. A systematic approach to evaluating expected returns to health technology assessment has not been readily taken up by research funders or assessors. This paper sets out a specific methodology for ex ante evaluation or triage and proposes a decision procedure, using alternative outcome scenarios and the associated policy changes and costs and benefits, against a background of likely clinical practice in the absence of the assessment. The methodology is used to consider implications of a proposed major clinical trial to assess the long term costs and benefits of hormone replacement therapy.     

Cost effectiveness of antenatal anti-D prophylaxis

This paper estimates the incremental cost-effectiveness of providing antenatal anti-D prophylaxis in varying dose sizes to either primigravidae or all Rh D negative women. It presents a model for calculating the net cost per 1000 ‘at risk’ women based on the costs of anti-D prophylaxis and the future NHS costs avoided. Incremental cost-effectiveness is measured in terms of the net cost per Rh D-alloimmunization and the net cost per Rh HD loss prevented. Programmes for Rh D negative primigravidae are more cost-effective than the same dose protocol extended to all Rh D negative women. The 1 × 1250 iu programme is the most cost-effective option.     

Cost effectiveness of workplace smoking policies

This study reviews the motivations of companies to set out a policy for controlling smoking, the economic benefits for the company resulting from such a policy and the costs, broken down by European Union countries. The literature on the costs of implementing a policy related to smoking at the workplace is reviewed. The main objective of policies related to smoking at the workplace is that of safeguarding employees from environmental tobacco smoke. Other reasons are cutting costs, improving the company image, and reducing absenteeism, occupational accidents, internal quarrels and extra costs due to cigarette smoking, protection against environmental tobacco smoke does not entail any higher costs for companies, and economic advantages are visible. The benefits are by far greater than the costs involved, particularly on a long-range basis, and seem to be greater when smoking at the workplace is completely prohibited and no smoking areas are set.     

耳鼻喉科医院感染管理成效分析

目的 通过规范科室医院感染管理，降低医院感染发生率。方法 健全组织，加强培训，实行监、控、管一体化管理。结果 医院感染管理成效明显，医院感染发生率由1．15％下降到0．3％，医院感染知识年终考核通过率达100％，平均成绩93．6分。结论 健全的组织，行之有效的培训，科学化的管理是促进科室规范化医院感染管理的重要保障。